Healthcare Provider Details

I. General information

NPI: 1841989092
Provider Name (Legal Business Name): NEETHU KURIEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 COLLEGE PARK DR STE A
RINGGOLD GA
30736-0600
US

IV. Provider business mailing address

PO BOX 1587
DALTON GA
30722-1587
US

V. Phone/Fax

Practice location:
  • Phone: 706-965-4060
  • Fax: 706-965-4080
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number111328
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: