MEDICARE: DR. JULIET KOTTAK MAVROMATIS M.D.

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
1	207R00000X	Internal Medicine Physician	043699	GA

General Provider Information

NPI Number	:	1528168747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIET KOTTAK MAVROMATIS M.D.

Provider Business Mailing Address
First Line	:	57 EXECUTIVE PARK S
Second Line	:	STE 390
City	:	ATLANTA
State	:	GA
Zip	:	30329-2288
Country	:	US
Telephone Number	:	404-997-6790
Fax Number	:

Provider Business Practice Location Address
First Line	:	57 EXECUTIVE PARK S
Second Line	:	STE 390
City	:	ATLANTA
State	:	GA
Zip	:	30329-2288
Country	:	US
Telephone Number	:	404-997-6790
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	02/07/2012

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