Provider Demographics
NPI:1124252374
Name:ANDRACHUK, JOHN STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STEVEN
Last Name:ANDRACHUK
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 1:1110 W PEACHTREE ST NW STE 950
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3609
Mailing Address - Country:US
Mailing Address - Phone:404-847-4210
Mailing Address - Fax:404-847-4211
Practice Address - Street 1:1110 W PEACHTREE ST NW STE 950
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3609
Practice Address - Country:US
Practice Address - Phone:404-847-4210
Practice Address - Fax:404-847-4211
Is Sole Proprietor?:No
Enumeration Date:2009-05-02
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA069532207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003139792AMedicaid
GA003139792BMedicaid
GA003139792CMedicaid
GA202I206750Medicare PIN