Provider Demographics
NPI:1700849874
Name:OPRYSKO, JOHN L (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:OPRYSKO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4445 COWAN RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4829
Mailing Address - Country:US
Mailing Address - Phone:770-938-0275
Mailing Address - Fax:770-939-6225
Practice Address - Street 1:4445 COWAN RD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4829
Practice Address - Country:US
Practice Address - Phone:770-938-0275
Practice Address - Fax:770-939-6225
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034211207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00476616BMedicaid
GA00476616BMedicaid
GAF02634Medicare UPIN