Healthcare Provider Details

I. General information

NPI: 1427001122
Provider Name (Legal Business Name): GEORGE Z KATSITADZE MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 FIVE FORKS TRICKUM ROAD SUITE102
LILBURN GA
30047
US

IV. Provider business mailing address

4120 FIVE FORKS TRICKUM RD SW SUTIE 102
LILBURN GA
30047-3133
US

V. Phone/Fax

Practice location:
  • Phone: 770-923-6400
  • Fax: 770-564-1697
Mailing address:
  • Phone: 770-923-6400
  • Fax: 770-564-1697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number052456
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: