Provider Demographics
NPI:1801848965
Name:MULCHAHEY, KRISTI M (MD)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:M
Last Name:MULCHAHEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 WINDY HILL RD SE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8665
Mailing Address - Country:US
Mailing Address - Phone:770-980-1818
Mailing Address - Fax:770-980-1873
Practice Address - Street 1:2550 WINDY HILL RD SE
Practice Address - Street 2:SUITE 115
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8665
Practice Address - Country:US
Practice Address - Phone:770-980-1818
Practice Address - Fax:770-980-1873
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034209174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00470082AMedicare ID - Type Unspecified
GAC74921Medicare UPIN