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General NPI Number Information
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NPI Number | 1386365567
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Entity Type | Individual
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Provider Name | KRISTOPHER NICHOLAS URBANOVITCH
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Gender | Male
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Dates
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Enumeration Date | 09/07/2022
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Last Update Date | 09/07/2022
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Provider Practice Location Address
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Address Line | 1670 CLAIRMONT RD # 508121
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City | DECATUR
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State | GA
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Zip | 30033-4004
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Country | US
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Telephone | 404-321-6111
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Fax |
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Provider Business Mailing Address
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Address Line | 3018 KENTMERE DR
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City | CUMMING
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State | GA
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Zip | 30040-1220
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Country | US
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Telephone | 770-371-8030
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Z00000X
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Taxonomy Name | Orthotist
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License Number | 131
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number | 131
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License Number State | GA
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