Provider Demographics
NPI:1881854594
Name:KARAKATTU, MONIKA S (MD)
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:S
Last Name:KARAKATTU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3747 ROSWELL RD STE 216
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6227
Mailing Address - Country:US
Mailing Address - Phone:770-973-2272
Mailing Address - Fax:
Practice Address - Street 1:3747 ROSWELL RD STE 216
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6227
Practice Address - Country:US
Practice Address - Phone:770-973-2272
Practice Address - Fax:770-973-9245
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49295207Q00000X
VA0101248825207Q00000X
SCMD87456207Q00000X
GA88331207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
597715OtherANTHEM
TNQ001344Medicaid
VA1881854594Medicaid
6085985OtherBCBST
4554549OtherCIGNA
VA1881854594Medicaid
VAV V2270AMedicare PIN
TN103I080862Medicare PIN