Provider Demographics
NPI:1972812881
Name:EBOO, KARIMA M
Entity Type:Individual
Prefix:
First Name:KARIMA
Middle Name:M
Last Name:EBOO
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 1:3156 SAINT IVES COUNTRY CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-2037
Mailing Address - Country:US
Mailing Address - Phone:678-640-2650
Mailing Address - Fax:770-497-8424
Practice Address - Street 1:3156 SAINT IVES COUNTRY CLUB PKWY
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-2037
Practice Address - Country:US
Practice Address - Phone:678-640-2650
Practice Address - Fax:770-497-8424
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT003993225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist