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Individual

MRS. KATHY S POODIACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1700 HOSPITAL SOUTH DRIVE, SUITE 300, AUSTELL, GA 30106-8116
(770) 944-2830
(678) 581-7170
Mailing address
1700 HOSPITAL SOUTH DRIVE, SUITE 300, AUSTELL, GA 30106-8116
(770) 944-2830
(678) 581-7170

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9104850
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
002325
STATE MEDICAL LICENSE
GA
01
GRP245
MEDICARE, GROUP NUMBER
GA
Enumeration date
11/05/2008
Last updated
11/10/2009
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