Healthcare Provider Details

I. General information

NPI: 1083674675
Provider Name (Legal Business Name): NANCY KRALOVICH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 06/06/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 MERIDIAN MARK RD STE 250
ATLANTA GA
30342-4767
US

IV. Provider business mailing address

5445 MERIDIAN MARK RD STE 250
ATLANTA GA
30342-4767
US

V. Phone/Fax

Practice location:
  • Phone: 404-255-1933
  • Fax: 404-256-7924
Mailing address:
  • Phone: 404-255-1933
  • Fax: 404-256-7924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4449
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: