Healthcare Provider Details

I. General information

NPI: 1639530546
Provider Name (Legal Business Name): ELIAS GEORGE KIKANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2016
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WOODRUFF CIR NE DEPT OF
ATLANTA GA
30322-1020
US

IV. Provider business mailing address

100 WOODRUFF CIR NE DEPT OF
ATLANTA GA
30322-1020
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-4803
  • Fax:
Mailing address:
  • Phone: 404-778-4803
  • 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 TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number95128
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number95128
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: