Provider Demographics
NPI:1093915464
Name:KORYTNAYA, EVGENIA (MD)
Entity Type:Individual
Prefix:DR
First Name:EVGENIA
Middle Name:
Last Name:KORYTNAYA
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 1:6000 SHAKERAG HL STE 116
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-6523
Mailing Address - Country:US
Mailing Address - Phone:404-500-9914
Mailing Address - Fax:404-760-0855
Practice Address - Street 1:6000 SHAKERAG HL STE 116
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-6523
Practice Address - Country:US
Practice Address - Phone:404-500-9914
Practice Address - Fax:404-760-0855
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA67496207RE0101X, 207RE0101X
IN01070236A207RE0101X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003224485AMedicaid
GA08003714OtherAMERIGROUP
GA003224485BMedicaid
GA003224485CMedicaid