Provider Demographics
NPI:1750499315
Name:GOROKHOV, TATYANA (MD)
Entity type:Individual
Prefix:DR
First Name:TATYANA
Middle Name:
Last Name:GOROKHOV
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 1:2012 HAROBI DR
Mailing Address - Street 2:STE B
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5161
Mailing Address - Country:US
Mailing Address - Phone:404-477-0400
Mailing Address - Fax:
Practice Address - Street 1:2012 HAROBI DR
Practice Address - Street 2:STE B
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5161
Practice Address - Country:US
Practice Address - Phone:404-477-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042048207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000786266EMedicaid
GA000786266EMedicaid
GA08BBXJSMedicare PIN