Provider Demographics
NPI:1922204817
Name:KOLAROVA, AMY LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LYNN
Last Name:KOLAROVA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 PEACHTREE RD NW FL 6
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1465
Mailing Address - Country:US
Mailing Address - Phone:404-352-2020
Mailing Address - Fax:
Practice Address - Street 1:2020 PEACHTREE RD NW FL 6
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1465
Practice Address - Country:US
Practice Address - Phone:404-352-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA081476208100000X, 2081P0301X
OH34011007208100000X
MDH688822081P0301X
OH0110072081P0301X
NE16242081P0301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0301XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationBrain Injury Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0093409Medicaid
AK1615781Medicaid
AKK165732Medicare PIN