Provider Demographics
NPI:1457086803
Name:PORTER, KARLIE SHEA (CPNP)
Entity Type:Individual
Prefix:
First Name:KARLIE
Middle Name:SHEA
Last Name:PORTER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 TREE LN STE 110
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6749
Mailing Address - Country:US
Mailing Address - Phone:770-972-0860
Mailing Address - Fax:770-972-0850
Practice Address - Street 1:1700 TREE LN STE 110
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6749
Practice Address - Country:US
Practice Address - Phone:770-972-0860
Practice Address - Fax:770-972-0850
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN263756363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics