Provider Demographics
NPI:1265693204
Name:BUDMAN, KEVIN A (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:A
Last Name:BUDMAN
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 1:5445 MERIDIAN MARKS RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4763
Mailing Address - Country:US
Mailing Address - Phone:404-255-2419
Mailing Address - Fax:404-591-2939
Practice Address - Street 1:5445 MERIDIAN MARKS RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4763
Practice Address - Country:US
Practice Address - Phone:404-255-2419
Practice Address - Fax:404-591-2939
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067396207W00000X, 207WX0110X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I188093OtherMEDICARE PTAN