Healthcare Provider Details

I. General information

NPI: 1093713208
Provider Name (Legal Business Name): KRISTIN A BOEHM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 08/25/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 HOWELL MILL RD NW STE 400
ATLANTA GA
30318-0919
US

IV. Provider business mailing address

922 HIGHLAND VW NE
ATLANTA GA
30306-3817
US

V. Phone/Fax

Practice location:
  • Phone: 404-881-0687
  • Fax: 404-873-9192
Mailing address:
  • Phone: 404-449-6187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number050130
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: