Provider Demographics
NPI:1881639003
Name:LOMASHVILI, KOBA A
Entity Type:Individual
Prefix:
First Name:KOBA
Middle Name:A
Last Name:LOMASHVILI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 N DECATUR RD NE
Mailing Address - Street 2:APT #4
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1044
Mailing Address - Country:US
Mailing Address - Phone:404-556-8190
Mailing Address - Fax:404-727-3425
Practice Address - Street 1:1639 PIERCE DR
Practice Address - Street 2:WMB 338
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-0001
Practice Address - Country:US
Practice Address - Phone:404-727-2525
Practice Address - Fax:404-727-3425
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053830207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology