Provider Demographics
NPI:1891844635
Name:HART, KARLENE MARIE (MD)
Entity Type:Individual
Prefix:MRS
First Name:KARLENE
Middle Name:MARIE
Last Name:HART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:KARLENE
Other - Middle Name:MARIE
Other - Last Name:BOSWELL-MINTAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5440 HILLANDALE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058
Mailing Address - Country:US
Mailing Address - Phone:404-365-0966
Mailing Address - Fax:
Practice Address - Street 1:5440 HILLANDALE DRIVE
Practice Address - Street 2:KAISER PERMANENTE PANOLA MEDICAL CENTER
Practice Address - City:LITHONIA
Practice Address - State:GU
Practice Address - Zip Code:30058
Practice Address - Country:US
Practice Address - Phone:770-322-3216
Practice Address - Fax:770-554-0058
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060561207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA792864163AMedicaid