Provider Demographics
NPI:1518903988
Name:PETE, KARL L (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:L
Last Name:PETE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1557 JANMAR RD
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5686
Mailing Address - Country:US
Mailing Address - Phone:678-344-8900
Mailing Address - Fax:678-666-5201
Practice Address - Street 1:2711 IRVIN WAY STE 102
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030
Practice Address - Country:US
Practice Address - Phone:678-344-8900
Practice Address - Fax:678-619-5240
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200301275208800000X
VA0101257639208800000X
GA79837208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H17923Medicare UPIN
NC89135KGMedicaid
NC2023900AMedicare ID - Type Unspecified