Provider Demographics
NPI:1477976538
Name:KRUPANSKY, CRAIG (PA-C)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:KRUPANSKY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5673 PEACHTREE DUNWOODY RD STE 825
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1771
Mailing Address - Country:US
Mailing Address - Phone:404-255-5595
Mailing Address - Fax:404-252-2780
Practice Address - Street 1:5673 PEACHTREE DUNWOODY RD STE 825
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1771
Practice Address - Country:US
Practice Address - Phone:404-255-5595
Practice Address - Fax:404-252-2780
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7093363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant