Provider Demographics
NPI:1255462784
Name:NARDELLI-OLKOWSKA, KRYSTYNA M (MD)
Entity type:Individual
Prefix:
First Name:KRYSTYNA
Middle Name:M
Last Name:NARDELLI-OLKOWSKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 HOLCOMB BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-1325
Mailing Address - Country:US
Mailing Address - Phone:770-263-7061
Mailing Address - Fax:770-840-0901
Practice Address - Street 1:724 HOLCOMB BRIDGE RD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1325
Practice Address - Country:US
Practice Address - Phone:770-263-7061
Practice Address - Fax:770-840-0901
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021915174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE01072Medicare ID - Type UnspecifiedPHYSICIAN