Provider Demographics
NPI:1477675502
Name:KULKIN, CHARLOTTE V (FNP)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:V
Last Name:KULKIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 BLUFFHAVEN WAY NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-4817
Mailing Address - Country:US
Mailing Address - Phone:404-256-3598
Mailing Address - Fax:
Practice Address - Street 1:1400 HOLCOMB BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-2190
Practice Address - Country:US
Practice Address - Phone:770-587-7044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN125915363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily