Healthcare Provider Details

I. General information

NPI: 1619395928
Provider Name (Legal Business Name): MOHAMED KORONFEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 EAGLES LANDING PKWY
STOCKBRIDGE GA
30281-5085
US

IV. Provider business mailing address

575 PROFESSIONAL DR STE 150
LAWRENCEVILLE GA
30046-3347
US

V. Phone/Fax

Practice location:
  • Phone: 678-604-1053
  • Fax:
Mailing address:
  • Phone: 678-312-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number83066
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number83066
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number83066
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: