Provider Demographics
NPI:1417213257
Name:KEROLUS, JULIA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:LYNN
Last Name:KEROLUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:LYNN
Other - Last Name:FRISENDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1218 W PACES FERRY RD NW STE 108
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-2308
Mailing Address - Country:US
Mailing Address - Phone:404-233-3937
Mailing Address - Fax:
Practice Address - Street 1:1218 W PACES FERRY RD NW STE 108
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2308
Practice Address - Country:US
Practice Address - Phone:404-233-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036145635207Y00000X
IL036.145635207YS0123X
GA89446207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery