Healthcare Provider Details

I. General information

NPI: 1508963679
Provider Name (Legal Business Name): MELISSA JO KOTTKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 JESSE HILL JR DR SE EMORY UNIVERSITY DEPARTMENT OF GYN/OB
ATLANTA GA
30303-3049
US

IV. Provider business mailing address

49 JESSE HILL JR DR SE EMORY UNIVERSITY DEPARTMENT OF GYN/OB
ATLANTA GA
30303-3049
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-1379
  • Fax: 404-778-1382
Mailing address:
  • Phone: 404-778-1379
  • Fax: 404-778-1382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number56216
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: