Provider Demographics
NPI:1609022664
Name:DZMITRYIEU, ALIAKSANDR (MD)
Entity Type:Individual
Prefix:
First Name:ALIAKSANDR
Middle Name:
Last Name:DZMITRYIEU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3822 WESLEY CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-4177
Mailing Address - Country:US
Mailing Address - Phone:404-823-0282
Mailing Address - Fax:470-732-4023
Practice Address - Street 1:146 BILL CARRUTH PKWY
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-3749
Practice Address - Country:US
Practice Address - Phone:470-732-4022
Practice Address - Fax:470-732-4023
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003831207R00000X, 208M00000X
NY268775207R00000X, 208M00000X
390200000X
GA71490208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03360607Medicaid
NY03360607Medicaid