Healthcare Provider Details

I. General information

NPI: 1306103858
Provider Name (Legal Business Name): CONSTANTINE ALFRED GALIFIANAKIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5448 YORKTOWNE DR
ATLANTA GA
30349-5317
US

IV. Provider business mailing address

5448 YORKTOWNE DR
ATLANTA GA
30349-5317
US

V. Phone/Fax

Practice location:
  • Phone: 877-345-3301
  • Fax:
Mailing address:
  • Phone: 877-345-3301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number78624
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: