Provider Demographics
NPI:1588666739
Name:PANZITTA, KAREN C (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:C
Last Name:PANZITTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1120 15TH ST
Mailing Address - Street 2:GEORGIA REGENTS MEDICAL ASSOCIATES
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0004
Mailing Address - Country:US
Mailing Address - Phone:706-721-9729
Mailing Address - Fax:706-721-8507
Practice Address - Street 1:1499 WALTON WAY STE 1400
Practice Address - Street 2:PHYSICIANS PRACTICE GROUP
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2603
Practice Address - Country:US
Practice Address - Phone:706-724-6100
Practice Address - Fax:706-724-1600
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA384462085B0100X, 2085U0001X
GA0384462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0060707879DMedicaid
SCQ38446Medicaid
GA591320OtherBLUE CROSS BLUE SHIELD
SCQ38446Medicaid
GA591320OtherBLUE CROSS BLUE SHIELD