Provider Demographics
NPI:1932108719
Name:KRAKOW, RICHARD A (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:KRAKOW
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 1:11685 ALPHARETTA HWY
Mailing Address - Street 2:STE 200
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4910
Mailing Address - Country:US
Mailing Address - Phone:770-442-3328
Mailing Address - Fax:770-664-6781
Practice Address - Street 1:11685 ALPHARETTA HWY
Practice Address - Street 2:200
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4910
Practice Address - Country:US
Practice Address - Phone:770-442-3328
Practice Address - Fax:770-664-6781
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016377174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00586561AMedicaid
GA142553OtherBCBS OF GA.
GAD40379Medicare UPIN
GA00586561AMedicaid