Healthcare Provider Details

I. General information

NPI: 1548243959
Provider Name (Legal Business Name): PAUL SKOKANIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MEDICAL CENTER BLVD
LAWRENCEVILLE GA
30046-7694
US

IV. Provider business mailing address

PO BOX 116156
ATLANTA GA
30368-6156
US

V. Phone/Fax

Practice location:
  • Phone: 678-312-3273
  • Fax: 678-312-3282
Mailing address:
  • Phone: 678-312-5525
  • Fax: 770-339-2120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number045967
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: