Healthcare Provider Details

I. General information

NPI: 1306072616
Provider Name (Legal Business Name): KATHLEEN M CARRIGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 01/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5775 GLENRIDGE DR STE B525
ATLANTA GA
30328-7134
US

IV. Provider business mailing address

5775 GLENRIDGE DR STE B525
ATLANTA GA
30328-7134
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-4709
  • Fax: 404-252-8482
Mailing address:
  • Phone: 404-252-4709
  • Fax: 404-252-8482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0070959
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: