1285922450 NPI number — MS. KATHARINE PERRY KAUFMAN PA-C

Table of content: NICOLE FOUNTAIN (NPI 1235748369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285922450 NPI number — MS. KATHARINE PERRY KAUFMAN PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAUFMAN
Provider First Name:
KATHARINE
Provider Middle Name:
PERRY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PERRY
Provider Other First Name:
KATHARINE
Provider Other Middle Name:
WILSON
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285922450
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4151 HOSPITAL DRIVE
Provider Second Line Business Mailing Address:
DERMATOLOGY CONSULTANTS
Provider Business Mailing Address City Name:
COVINGTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-784-0343
Provider Business Mailing Address Fax Number:
404-215-9222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4151 HOSPITAL DR NE
Provider Second Line Business Practice Location Address:
DERMATOLOGY CONSULTANTS
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30014-2565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-784-0343
Provider Business Practice Location Address Fax Number:
404-215-9222
Provider Enumeration Date:
07/21/2011

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: 363A00000X , with the licence number:  202I975855 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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