Provider Demographics
NPI:1750839064
Name:PUSATERI, KARRIE
Entity Type:Individual
Prefix:
First Name:KARRIE
Middle Name:
Last Name:PUSATERI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 OLD MILTON PKWY # C
Mailing Address - Street 2:STE 290
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3707
Mailing Address - Country:US
Mailing Address - Phone:770-667-4337
Mailing Address - Fax:770-667-4338
Practice Address - Street 1:1505 NORTHSIDE FORSYTH BLVD
Practice Address - Street 2:STE 3500
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041
Practice Address - Country:US
Practice Address - Phone:770-292-6500
Practice Address - Fax:770-292-6535
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN200827363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003182349BMedicaid
GA003182349AMedicaid
GA003182349CMedicaid
GA003182349BMedicaid