Provider Demographics
NPI:1770583650
Name:EARLES, KATHI A (MD)
Entity type:Individual
Prefix:DR
First Name:KATHI
Middle Name:A
Last Name:EARLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 PIEDMONT AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-2544
Mailing Address - Country:US
Mailing Address - Phone:404-756-1410
Mailing Address - Fax:404-756-1495
Practice Address - Street 1:75 PIEDMONT AVE NE STE 700
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-2526
Practice Address - Country:US
Practice Address - Phone:404-756-1433
Practice Address - Fax:404-756-1357
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047312208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00837636AMedicaid
37BBFJSMedicare ID - Type Unspecified
G24877Medicare UPIN