Provider Demographics
NPI:1104183086
Name:GEORGIEV, KRUM (DPM, CWSP)
Entity Type:Individual
Prefix:DR
First Name:KRUM
Middle Name:
Last Name:GEORGIEV
Suffix:
Gender:M
Credentials:DPM, CWSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5440 LILBURN STONE MOUNTAIN RD STE A
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-2879
Mailing Address - Country:US
Mailing Address - Phone:404-474-4714
Mailing Address - Fax:404-474-2703
Practice Address - Street 1:5440 LILBURN STONE MOUNTAIN RD STE A
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-2879
Practice Address - Country:US
Practice Address - Phone:404-474-4714
Practice Address - Fax:404-474-2703
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001384213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300132983Medicare PIN