Provider Demographics
NPI:1386672095
Name:KOBLASZ, MARY AUGUSTA (RN, CNS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:AUGUSTA
Last Name:KOBLASZ
Suffix:
Gender:F
Credentials:RN, CNS
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Mailing Address - Street 1:210 AERIE CT
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-2801
Mailing Address - Country:US
Mailing Address - Phone:770-650-0602
Mailing Address - Fax:
Practice Address - Street 1:80 JESSE HILL JR DR SE
Practice Address - Street 2:DEPT OF PSYCHIATRY
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3031
Practice Address - Country:US
Practice Address - Phone:404-616-4762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN055134364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health