=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164207650
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MUNA FERTILITY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2023
-----------------------------------------------------
Last Update Date | 08/31/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2625 PIEDMONT RD NE STE 56-302
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30324-3086
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-387-9709
-----------------------------------------------------
Fax | 404-800-0048
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2625 PIEDMONT RD NE STE 56-302
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30324-3086
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-387-9709
-----------------------------------------------------
Fax | 404-800-0048
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER AND MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. KARENNE FRU
-----------------------------------------------------
Credential | MD/PHD
-----------------------------------------------------
Telephone | 864-387-9709
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VE0102X
-----------------------------------------------------
Taxonomy Name | Reproductive Endocrinology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------