Healthcare Provider Details

I. General information

NPI: 1619275427
Provider Name (Legal Business Name): GLORIVEL M. KOURY DE RAMOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 COLLIER RD NW STE 2000
ATLANTA GA
30309-1734
US

IV. Provider business mailing address

105 COLLIER RD NW STE 2000
ATLANTA GA
30309-1734
US

V. Phone/Fax

Practice location:
  • Phone: 404-350-1122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number70622
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME109294
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number70622
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: