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NPI Code Detail

MEDICARE: MRS. AMANDA KATHRYN KLOSKY PAC

MEDICARE: MRS. AMANDA KATHRYN KLOSKY PAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant3264GA
2364SM0705XMedical-Surgical Clinical Nurse Specialist003264GA
3363AS0400XSurgical Physician Assistant3264GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487646287
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMANDA KATHRYN KLOSKY PAC
Provider Business Mailing Address
First Line : 21 ORTHO LN
Second Line :
City : ATLANTA
State : GA
Zip : 30329-2315
Country : US
Telephone Number : 404-778-3350
Fax Number :
Provider Business Practice Location Address
First Line : 21 ORTHO LN
Second Line :
City : ATLANTA
State : GA
Zip : 30329-2315
Country : US
Telephone Number : 404-778-3350
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2005
Last Update Date : 02/22/2022

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