Provider Demographics
NPI:1104679299
Name:ATOKA MEDICAL CLINIC, INC
Entity type:Organization
Organization Name:ATOKA MEDICAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER, OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:KORSZOLOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:901-296-1156
Mailing Address - Street 1:60 COMMERCIAL DR
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:TN
Mailing Address - Zip Code:38004-7042
Mailing Address - Country:US
Mailing Address - Phone:901-296-1156
Mailing Address - Fax:901-296-0430
Practice Address - Street 1:60 COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:TN
Practice Address - Zip Code:38004-7042
Practice Address - Country:US
Practice Address - Phone:901-296-1156
Practice Address - Fax:901-296-0430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty