Healthcare Provider Details

I. General information

NPI: 1952373615
Provider Name (Legal Business Name): ANDREY POPYKIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 12/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 CHURCH ST NE SUITE 250
MARIETTA GA
30060-7282
US

IV. Provider business mailing address

790 CHURCH ST NE SUITE 250
MARIETTA GA
30060-7282
US

V. Phone/Fax

Practice location:
  • Phone: 678-797-8201
  • Fax: 678-797-8259
Mailing address:
  • Phone: 678-797-8201
  • Fax: 678-797-8259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number051715
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: