Provider Demographics
NPI:1508954298
Name:RAVIELE, KATHLEEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:M
Last Name:RAVIELE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2799 LAWRENCEVILLE HWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-2517
Mailing Address - Country:US
Mailing Address - Phone:770-491-0255
Mailing Address - Fax:770-491-8157
Practice Address - Street 1:2799 LAWRENCEVILLE HWY
Practice Address - Street 2:SUITE 110
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-2517
Practice Address - Country:US
Practice Address - Phone:770-491-0255
Practice Address - Fax:770-491-8157
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2015-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA020801207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000179935CMedicaid
GA160056472OtherMEDICARE RAILROAD PALMETT
GA7406947OtherUNITED HEALTHCARE
GA16BDCCBOtherPTAN
GA16BDCCBOtherPTAN
GA000179935CMedicaid
GA160056472OtherMEDICARE RAILROAD PALMETT