Healthcare Provider Details

I. General information

NPI: 1043328362
Provider Name (Legal Business Name): ANDRO GEORGE KACHARAVA MD,PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 CLAIRMONT RD
DECATUR GA
30033-4004
US

IV. Provider business mailing address

920 WENDOVER DR NE
ATLANTA GA
30319-1217
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-6111
  • Fax: 404-329-2211
Mailing address:
  • Phone: 404-816-5936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number046868
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: