Provider Demographics
NPI:1639218571
Name:GOLD, KARA WALDROP (ANP-C)
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:WALDROP
Last Name:GOLD
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 HAMMOND DR NE
Mailing Address - Street 2:STE G7105
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5338
Mailing Address - Country:US
Mailing Address - Phone:770-351-0900
Mailing Address - Fax:770-351-0993
Practice Address - Street 1:1140 HAMMOND DR NE
Practice Address - Street 2:STE G7105
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5338
Practice Address - Country:US
Practice Address - Phone:770-351-0900
Practice Address - Fax:770-351-0993
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN113630363LA2200X
GA26677207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000327247EMedicaid
GA000327247EMedicaid