Provider Demographics
NPI:1972820975
Name:VISCUSI, KATHLEEN SIKORA (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:SIKORA
Last Name:VISCUSI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ELIZABETH
Other - Last Name:SIKORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4800 OLDE TOWNE PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4428
Mailing Address - Country:US
Mailing Address - Phone:770-971-3376
Mailing Address - Fax:770-578-8567
Practice Address - Street 1:4800 OLDE TOWNE PKWY STE 250
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4428
Practice Address - Country:US
Practice Address - Phone:770-971-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA074424207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I074447Medicare UPIN