1063445021 NPI number — DR. KARINA KHOURI BELINFANTE M.D.

Table of content: DR. KARINA KHOURI BELINFANTE M.D. (NPI 1063445021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063445021 NPI number — DR. KARINA KHOURI BELINFANTE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELINFANTE
Provider First Name:
KARINA
Provider Middle Name:
KHOURI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KHOURI
Provider Other First Name:
KARINA
Provider Other Middle Name:
RAQUEL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1063445021
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3969 S COBB DR SE
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
SMYRNA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30080-6358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-438-1002
Provider Business Mailing Address Fax Number:
770-438-7223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3969 S COBB DR SE
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
SMYRNA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30080-6358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-438-1002
Provider Business Practice Location Address Fax Number:
770-438-7223
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  55726 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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