Provider Demographics
NPI:1962790550
Name:SKLYAR, TATYANA Y (MD)
Entity type:Individual
Prefix:DR
First Name:TATYANA
Middle Name:Y
Last Name:SKLYAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1835 SAVOY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1071
Mailing Address - Country:US
Mailing Address - Phone:478-745-6130
Mailing Address - Fax:478-745-4443
Practice Address - Street 1:308 COLISEUM DR STE 120
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3859
Practice Address - Country:US
Practice Address - Phone:478-745-6130
Practice Address - Fax:478-745-4443
Is Sole Proprietor?:No
Enumeration Date:2011-07-16
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT198361207R00000X
GA077786207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I839371OtherMEDICARE PTAN
GA003190804CMedicaid
GA003190804BMedicaid