Provider Demographics
NPI:1801907472
Name:CARLSON WRAMMERT, KATHRYN A (NP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:CARLSON WRAMMERT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:A
Other - Last Name:CARLSON WRAMMERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN, ANP-BC, WHNP-BC
Mailing Address - Street 1:1365 CLIFTON RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:404-778-1900
Mailing Address - Fax:
Practice Address - Street 1:1365 CLIFTON RD NE BLDG C
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-778-1900
Practice Address - Fax:404-778-5676
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA169458363LA2200X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ25449Medicare UPIN