Provider Demographics
NPI:1033143011
Name:KRAWIECKI, NICOLAS S (MD)
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:S
Last Name:KRAWIECKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 UPPER GATE DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1014
Mailing Address - Country:US
Mailing Address - Phone:404-727-9372
Mailing Address - Fax:
Practice Address - Street 1:2015 UPPER GATE DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1014
Practice Address - Country:US
Practice Address - Phone:404-727-9372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0228042080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA649800OtherBLUE CROSS BLUE SHIELD
GA649800OtherBLUE CROSS BLUE SHIELD
D45883Medicare UPIN