Healthcare Provider Details

I. General information

NPI: 1417213257
Provider Name (Legal Business Name): JULIA LYNN KEROLUS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIA LYNN FRISENDA MD

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 03/30/2024
Certification Date: 03/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 W PACES FERRY RD NW STE 108
ATLANTA GA
30327-2308
US

IV. Provider business mailing address

1218 W PACES FERRY RD NW STE 108
ATLANTA GA
30327-2308
US

V. Phone/Fax

Practice location:
  • Phone: 404-233-3937
  • Fax:
Mailing address:
  • Phone: 404-233-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number036145635
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number036.145635
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number89446
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: