Provider Demographics
NPI:1962644476
Name:BROCK, KATHARINE ELIZABETH (MD, MS)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:ELIZABETH
Last Name:BROCK
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Gender:F
Credentials:MD, MS
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Mailing Address - Street 1:1405 CLIFTON RD NE
Mailing Address - Street 2:BRUMLEY BRIDGE AFLAC SUITE, HSRB W-340B
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-4532
Mailing Address - Country:US
Mailing Address - Phone:404-785-4741
Mailing Address - Fax:404-727-4455
Practice Address - Street 1:1405 CLIFTON RD NE
Practice Address - Street 2:BRUMLEY BRIDGE AFLAC SUITE, HSRB W-340B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-4532
Practice Address - Country:US
Practice Address - Phone:404-785-4741
Practice Address - Fax:404-727-4455
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2016-11-03
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Provider Licenses
StateLicense IDTaxonomies
GA763092080P0207X, 2080H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative Medicine