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Individual

KAREN ANNE PORTER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
P.T.

Contact information

Practice address
909 EAGLES LANDING PKWY STE 430, STOCKBRIDGE, GA 30281-6398
(770) 506-6993
(770) 506-6994
Mailing address
109 CREEKSIDE CT, GRIFFIN, GA 30223-5891
(262) 215-4551

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
4381-024
WI
225100000X
Physical Therapist
Primary
PT011776
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
392039073012
BLUE CROSS/BLUE SHIELD ID
WI
Enumeration date
10/04/2006
Last updated
03/17/2018
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