MEDICARE: DR. RICARDO BRASILIANO AKSTEIN M.D.

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	207W00000X	Ophthalmology Physician	018778	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GRP925	OTHER	GA	MEDICARE GROUP NUMBER

General Provider Information

NPI Number	:	1740284736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICARDO BRASILIANO AKSTEIN M.D.

Provider Business Mailing Address
First Line	:	86 UPPER RIVERDALE RD
Second Line	:	SUITE 100
City	:	RIVERDALE
State	:	GA
Zip	:	30274
Country	:	US
Telephone Number	:	770-996-4844
Fax Number	:	770-907-0884

Provider Business Practice Location Address
First Line	:	86 UPPER RIVERDALE RD
Second Line	:	SUITE 100
City	:	RIVERDALE
State	:	GA
Zip	:	30274
Country	:	US
Telephone Number	:	770-996-4844
Fax Number	:	770-907-0884

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	03/05/2025

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