Provider Demographics
NPI:1033108121
Name:KLICIUS, ROMUALDA S (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMUALDA
Middle Name:S
Last Name:KLICIUS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2230 TOWNE LAKE PKWY
Mailing Address - Street 2:BUILDING 300, SUITE 100
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5540
Mailing Address - Country:US
Mailing Address - Phone:770-517-1900
Mailing Address - Fax:770-926-3215
Practice Address - Street 1:2230 TOWNE LAKE PKWY
Practice Address - Street 2:BUILDING 300, SUITE 100
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5540
Practice Address - Country:US
Practice Address - Phone:770-517-1900
Practice Address - Fax:770-926-3215
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2011-12-12
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Provider Licenses
StateLicense IDTaxonomies
GA046305208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics