Provider Demographics
NPI:1750377883
Name:KRETZSCHMAR, CLAUDIA SUZANNE (MD)
Entity type:Individual
Prefix:DR
First Name:CLAUDIA
Middle Name:SUZANNE
Last Name:KRETZSCHMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 OGLETHORPE AVE
Mailing Address - Street 2:STE B1
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2221
Mailing Address - Country:US
Mailing Address - Phone:706-549-9537
Mailing Address - Fax:706-549-1228
Practice Address - Street 1:700 OGLETHORPE AVE
Practice Address - Street 2:STE B1
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2221
Practice Address - Country:US
Practice Address - Phone:706-549-9537
Practice Address - Fax:706-549-1228
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA29017207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00336245CMedicaid
D29985Medicare UPIN