Provider Demographics
NPI:1346295441
Name:KAREN BUTLER, MD, LLC
Entity Type:Organization
Organization Name:KAREN BUTLER, MD, LLC
Other - Org Name:KAREN L. BUTLER, MD, S
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-494-8389
Mailing Address - Street 1:945 OAKLAWN DR
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-5730
Mailing Address - Country:US
Mailing Address - Phone:478-494-8389
Mailing Address - Fax:877-991-3106
Practice Address - Street 1:310 US HIGHWAY 1 BYP S
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:GA
Practice Address - Zip Code:30434-6432
Practice Address - Country:US
Practice Address - Phone:478-494-8389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43732-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34261200Medicaid
WI34261200Medicaid