Provider Demographics
NPI:1780669721
Name:KORANSKY, JACK RALPH (MD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:RALPH
Last Name:KORANSKY
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1700 HOSPITAL SOUTH DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-6810
Mailing Address - Country:US
Mailing Address - Phone:678-741-2317
Mailing Address - Fax:678-741-2301
Practice Address - Street 1:711 CANTON RD NE
Practice Address - Street 2:SUITE 300
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8948
Practice Address - Country:US
Practice Address - Phone:770-429-0031
Practice Address - Fax:678-819-4299
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2011-04-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA016810207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00185248DMedicaid
GA10BBCCDMedicare ID - Type Unspecified
GA00185248DMedicaid