Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 01070236A | IN |
N | 111NI0900X | Internist | 01070236A | IN |
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | 01070236A | IN |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 67496 | GA |
NPI | 1093915464 |
---|---|
Provider Name | Dr. Evgenia Korytnaya |
First Address | Gainesville, GA 30503-0658 |
Second Address | Gainesville, GA 30501-3834 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2007 |
Last Update Date | 10/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003224485A | (05) | GA |
003224485B | (05) | GA |
003224485C | (05) | GA |
08003714 | AMERIGROUP (01) | GA |