Healthcare Provider Details

I. General information

NPI: 1114011988
Provider Name (Legal Business Name): JULIA EASTON KAUFMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5665 NEW NORTHSIDE DR NW SUITE 320
ATLANTA GA
30328-5831
US

IV. Provider business mailing address

5245 STERLING COVE CT
MABLETON GA
30126-7615
US

V. Phone/Fax

Practice location:
  • Phone: 310-429-6470
  • Fax:
Mailing address:
  • Phone: 770-739-9850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number61276
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberA86246
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: