Provider Demographics
NPI:1700840147
Name:KOZARSKY, ALAN M (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:M
Last Name:KOZARSKY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3225 CUMBERLAND BLVD SE
Mailing Address - Street 2:SUITE 900
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6407
Mailing Address - Country:US
Mailing Address - Phone:404-351-2220
Mailing Address - Fax:404-355-5624
Practice Address - Street 1:3193 HOWELL MILL RD NW STE 115
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2100
Practice Address - Country:US
Practice Address - Phone:404-350-1425
Practice Address - Fax:404-350-1429
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2020-10-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA023619207WX0120X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000246991CMedicaid
GA000246991CMedicaid
GA00965Medicare PIN
GAC30849Medicare PIN
GA202I189374Medicare PIN