Healthcare Provider Details

I. General information

NPI: 1568863215
Provider Name (Legal Business Name): KATHRYNE BROOKE DRUCKER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 09/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 SHALLOWFORD RD
MARIETTA GA
30062-1266
US

IV. Provider business mailing address

8895 CARROLL MANOR DR
SANDY SPRINGS GA
30350-2079
US

V. Phone/Fax

Practice location:
  • Phone: 678-560-7160
  • Fax:
Mailing address:
  • Phone: 678-641-7687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN192005
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: