Provider Demographics
NPI:1922116599
Name:GOROKHOV, MIKHAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:MIKHAIL
Middle Name:
Last Name:GOROKHOV
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 1:2012 HAROBI DR
Mailing Address - Street 2:STE B
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5161
Mailing Address - Country:US
Mailing Address - Phone:404-320-6050
Mailing Address - Fax:
Practice Address - Street 1:2910 N DRUID HILLS RD NE
Practice Address - Street 2:STE A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-3919
Practice Address - Country:US
Practice Address - Phone:404-320-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039353207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00662219EMedicaid
GA08BBXJXMedicare ID - Type Unspecified
GA00662219EMedicaid