Provider Demographics
NPI:1083605687
Name:TAVROVSKY, LYUDMILA (MD)
Entity Type:Individual
Prefix:MRS
First Name:LYUDMILA
Middle Name:
Last Name:TAVROVSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 JOHNSON FERRY RD
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4946
Mailing Address - Country:US
Mailing Address - Phone:404-250-6400
Mailing Address - Fax:404-250-6405
Practice Address - Street 1:137 JOHNSON FERRY RD
Practice Address - Street 2:SUITE 1200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4946
Practice Address - Country:US
Practice Address - Phone:404-250-6400
Practice Address - Fax:404-250-6405
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053190207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA838567067AMedicaid
GA838567067BMedicaid
11BDXBTMedicare ID - Type Unspecified
GA838567067AMedicaid
GA202I111972Medicare PIN