Healthcare Provider Details

I. General information

NPI: 1770583650
Provider Name (Legal Business Name): KATHI A EARLES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 PIEDMONT AVE NE STE 700
ATLANTA GA
30303-2526
US

IV. Provider business mailing address

75 PIEDMONT AVE SUITE 700
ATLANTA GA
30303-2544
US

V. Phone/Fax

Practice location:
  • Phone: 404-756-1433
  • Fax: 404-756-1357
Mailing address:
  • Phone: 404-756-1410
  • Fax: 404-756-1495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number047312
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: