Provider Demographics
NPI:1093713208
Name:BOEHM, KRISTIN A (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:A
Last Name:BOEHM
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 1:922 HIGHLAND VW NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-3817
Mailing Address - Country:US
Mailing Address - Phone:404-449-6187
Mailing Address - Fax:
Practice Address - Street 1:3286 NORTHSIDE PKWY NW STE 1000
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2294
Practice Address - Country:US
Practice Address - Phone:404-841-8450
Practice Address - Fax:404-841-8453
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0501302086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00962068BMedicaid
GA24BCBTDMedicare ID - Type Unspecified
GA00962068BMedicaid