Provider Demographics
NPI:1184200073
Name:KIROLLOS, ANIA BETH
Entity Type:Individual
Prefix:
First Name:ANIA
Middle Name:BETH
Last Name:KIROLLOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5126 PEACHTREE BLVD APT 211
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-3251
Mailing Address - Country:US
Mailing Address - Phone:518-524-6370
Mailing Address - Fax:
Practice Address - Street 1:5126 PEACHTREE BLVD APT 211
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-3251
Practice Address - Country:US
Practice Address - Phone:518-524-6370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA290355363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health