Provider Demographics
NPI:1891176251
Name:CRISTEA, OCTAV (MD)
Entity Type:Individual
Prefix:MR
First Name:OCTAV
Middle Name:
Last Name:CRISTEA
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 1:101 WOODRUFF CIRCLE
Mailing Address - Street 2:SUITE 5105 WMB
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322
Mailing Address - Country:US
Mailing Address - Phone:404-712-1820
Mailing Address - Fax:
Practice Address - Street 1:1365 CLIFTON ROAD NORTHEAST
Practice Address - Street 2:BUILDING B, 6TH FLOOR
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322
Practice Address - Country:US
Practice Address - Phone:855-366-7989
Practice Address - Fax:404-727-3660
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2018-09-27
Deactivation Date:2015-12-11
Deactivation Code:
Reactivation Date:2018-08-01
Provider Licenses
StateLicense IDTaxonomies
GA81354204F00000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery