Provider Demographics
NPI:1518949528
Name:KESSLER, ALEXANDER TKESHELASHVILI (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:TKESHELASHVILI
Last Name:KESSLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALEXANDER
Other - Middle Name:
Other - Last Name:TKESHELASHVILI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 MEDICAL LN
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2417
Mailing Address - Country:US
Mailing Address - Phone:770-345-2300
Mailing Address - Fax:770-345-2330
Practice Address - Street 1:50 MEDICAL LANE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2417
Practice Address - Country:US
Practice Address - Phone:770-345-2300
Practice Address - Fax:770-345-2330
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050647207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00958009AMedicaid
GA00958009AMedicaid
11BDVNDMedicare ID - Type Unspecified