Provider Demographics
NPI:1346245925
Name:WROTNOWSKI, UTE (MD)
Entity Type:Individual
Prefix:
First Name:UTE
Middle Name:
Last Name:WROTNOWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 BUCKEYE RD
Mailing Address - Street 2:STE 178
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4232
Mailing Address - Country:US
Mailing Address - Phone:770-458-6103
Mailing Address - Fax:770-234-0437
Practice Address - Street 1:3300 BUCKEYE RD
Practice Address - Street 2:STE 178
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4232
Practice Address - Country:US
Practice Address - Phone:770-458-6103
Practice Address - Fax:770-234-0437
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033761207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00439766AMedicaid
GA22BDBWRMedicare ID - Type Unspecified
GA00439766AMedicaid