MEDICARE: DR. VIKTORIA NURPEISOV MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	64686	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699923169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIKTORIA NURPEISOV MD

Provider Business Mailing Address
First Line	:	582 CONCORD RD SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30082-2616
Country	:	US
Telephone Number	:	470-956-4000
Fax Number	:	770-319-5703

Provider Business Practice Location Address
First Line	:	582 CONCORD RD SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30082-2616
Country	:	US
Telephone Number	:	470-956-4000
Fax Number	:	770-319-5703

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2008
Last Update Date	:	07/21/2022

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