Healthcare Provider Details

I. General information

NPI: 1861951881
Provider Name (Legal Business Name): ALEXEY VIKTOROVICH BABAK MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 01/04/2025
Certification Date: 01/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 N DECATUR RD
DECATUR GA
30033-5918
US

IV. Provider business mailing address

3425 N DRUID HILLS RD APT E
DECATUR GA
30033-3716
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-9729
  • Fax:
Mailing address:
  • Phone: 346-323-1142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number102432
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberTRN28103
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: