Healthcare Provider Details

I. General information

NPI: 1619139425
Provider Name (Legal Business Name): KARA KERSCHER PRICKETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 UPPERGATE DR NE
ATLANTA GA
30322-0001
US

IV. Provider business mailing address

2015 UPPERGATE DR NE
ATLANTA GA
30322-0001
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-2000
  • Fax: 404-785-9037
Mailing address:
  • Phone: 404-785-2000
  • Fax: 404-785-9037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number072087
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: