Organization
KATHLEEN M. RAVIELE, MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL H GARRISON (INSURANCE)
(770) 491-0255
Entity
Organization
Contact information
Practice address
2799 LAWRENCEVILLE HWY, SUITE 110, DECATUR, GA 30033-2517
(770) 491-0255
(770) 491-8157
Mailing address
2799 LAWRENCEVILLE HWY, SUITE 110, DECATUR, GA 30033-2517
(770) 491-0255
(770) 491-8157
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
020801
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000179935C
—
GA
01
—
16BDCCB
MEDICARE PTAN
GA
Enumeration date
09/05/2012
Last updated
07/09/2015
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