Provider Demographics
NPI:1750607586
Name:TSYMBALOV, KONSTANTIN SERGEYEVICH (DO)
Entity type:Individual
Prefix:
First Name:KONSTANTIN
Middle Name:SERGEYEVICH
Last Name:TSYMBALOV
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:410 CREEKSTONE RDG
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3740
Mailing Address - Country:US
Mailing Address - Phone:678-909-0911
Mailing Address - Fax:678-909-0912
Practice Address - Street 1:3459 ACWORTH DUE WEST RD NW STE 117
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-5820
Practice Address - Country:US
Practice Address - Phone:678-521-1105
Practice Address - Fax:678-909-0912
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA744112081P2900X
FLOS125892081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine