Provider Demographics
NPI:1407960115
Name:PORTER-BANKS, DORIS E (CNS)
Entity Type:Individual
Prefix:MS
First Name:DORIS
Middle Name:E
Last Name:PORTER-BANKS
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:DORIS
Other - Middle Name:E
Other - Last Name:BANKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNS
Mailing Address - Street 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1773
Mailing Address - Country:US
Mailing Address - Phone:404-364-7000
Mailing Address - Fax:
Practice Address - Street 1:2525 CUMBERLAND PKWY SE
Practice Address - Street 2:KP CUMBERLAND MEDICAL OFFICE
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3915
Practice Address - Country:US
Practice Address - Phone:770-431-4235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN086314364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health