Viktor Bouquette, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

026769 Issued in GA

Practice address

4646 N. Shallowford Road
Atlanta, GA 30338

Phone

(770) 676-6000

Fax

(770) 392-9805

NPI assigned

Apr 19, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Viktor Bouquette Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 1, 2012 through Oct 1, 2026

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073730552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4646 N. SHALLOWFORD ROAD",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30338",
            "telephone_number": "770-676-6000",
            "fax_number": "770-392-9805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4646 N. SHALLOWFORD ROAD",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30338",
            "telephone_number": "770-676-6000",
            "fax_number": "770-392-9805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUQUETTE",
        "first_name": "VIKTOR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "026769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VIKTOR",
            "last_name": "BOUQUETTE",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Joyce A Bouknight Gant, REGISTERED NURSE
• Emerson Bouldin
• Briana Jewel Boulin
• Nicholas M Boulis, MD
• Gary F Bouloux, MD, DDS
• Andrei Petrovich Bourdeinyi, D.C.
• Denise Dorothy Bourg, PT
• Kristin Bourg, PA
• Debra Bourgeois, CCC-SLP
• Caitlin Adrianna Bourland, APC

• Specialist in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.