Provider Demographics
NPI:1245466036
Name:KOWALCHUK, DEBORAH ANN (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ANN
Last Name:KOWALCHUK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6335 HOSPITAL PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1549
Mailing Address - Country:US
Mailing Address - Phone:404-575-4500
Mailing Address - Fax:404-575-4555
Practice Address - Street 1:6335 HOSPITAL PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1549
Practice Address - Country:US
Practice Address - Phone:404-575-4500
Practice Address - Fax:404-575-4555
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA241059207X00000X
TXQ0092207XX0004X
GA073800207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003168359AMedicaid
GA202I205232Medicare PIN