Provider Demographics
NPI:1619951092
Name:CRITZ, FRANK A (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:A
Last Name:CRITZ
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:PO BOX 116470
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2339
Mailing Address - Country:US
Mailing Address - Phone:770-682-2080
Mailing Address - Fax:
Practice Address - Street 1:2349 LAWRENCEVILLE HWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3143
Practice Address - Country:US
Practice Address - Phone:404-320-1550
Practice Address - Fax:404-728-1081
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018007174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000190424FMedicaid
GA00190242BMedicaid
GAE81785Medicare UPIN
GA30BDNJNMedicare PIN