Provider Demographics
NPI:1841214822
Name:KIRSCHBAUM, PAUL ALLAN (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ALLAN
Last Name:KIRSCHBAUM
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 1:2665 N DECATUR RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6149
Mailing Address - Country:US
Mailing Address - Phone:404-297-9077
Mailing Address - Fax:404-296-1220
Practice Address - Street 1:2665 N DECATUR RD
Practice Address - Street 2:SUITE 260
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6149
Practice Address - Country:US
Practice Address - Phone:404-297-9077
Practice Address - Fax:404-296-1220
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021728207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000239434IMedicaid
GA021728OtherGA LICENSE
GA021728OtherGA LICENSE
D29938Medicare UPIN