Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 038281 | GA |
NPI | 1609925445 |
---|---|
Provider Name | Prof. Athena P Kourtis |
First Address | Atlanta, GA 30328-6753 |
Second Address | Kennesaw, GA 30144-6812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 08/07/2007 |