Healthcare Provider Details

I. General information

NPI: 1891897492
Provider Name (Legal Business Name): KARL ASTAPHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 ROUTE 30 N
BOMOSEEN VT
05732-9647
US

IV. Provider business mailing address

PO BOX 459
COLBERT GA
30628-0459
US

V. Phone/Fax

Practice location:
  • Phone: 802-468-5641
  • Fax:
Mailing address:
  • Phone: 706-788-3234
  • Fax: 706-788-2936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number037941
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: