Provider Demographics
NPI:1811988728
Name:KAGAN, STEPHEN A (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:A
Last Name:KAGAN
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 1:2484 BRIARCLIFF RD NE
Mailing Address - Street 2:SUITE # 24
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3011
Mailing Address - Country:US
Mailing Address - Phone:404-231-4431
Mailing Address - Fax:404-231-5677
Practice Address - Street 1:2484 BRIARCLIFF RD NE
Practice Address - Street 2:SUITE # 24
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-3011
Practice Address - Country:US
Practice Address - Phone:404-231-4431
Practice Address - Fax:404-231-5677
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034381174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA44ZCBHLMedicare ID - Type UnspecifiedMEDICARE ID
GAE59857Medicare UPIN