Provider Demographics
NPI:1558870113
Name:HILAIRE, VLADIMYR KUVAROV (CSFA)
Entity Type:Individual
Prefix:MR
First Name:VLADIMYR
Middle Name:KUVAROV
Last Name:HILAIRE
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8211 BLACKFOOT TRL
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-3912
Mailing Address - Country:US
Mailing Address - Phone:404-954-0790
Mailing Address - Fax:
Practice Address - Street 1:8211 BLACKFOOT TRL
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-3912
Practice Address - Country:US
Practice Address - Phone:404-954-0790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-27
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA178053246ZC0007X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant