Healthcare Provider Details

I. General information

NPI: 1790007003
Provider Name (Legal Business Name): CLAUDIA INGRID POOLSON RPA, RRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2010
Last Update Date: 02/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5665 PEACHTREE DUNWOODY RD NE
ATLANTA GA
30342-1764
US

IV. Provider business mailing address

1580 COMMERCE DR A-4
DECATUR GA
30030-3127
US

V. Phone/Fax

Practice location:
  • Phone: 678-843-5365
  • Fax: 678-843-5357
Mailing address:
  • Phone: 404-421-6838
  • Fax: 678-843-5357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License Number304252
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: