Provider Demographics
NPI:1285766055
Name:PAULSEN, ANNAMARIE S (MD)
Entity type:Individual
Prefix:MRS
First Name:ANNAMARIE
Middle Name:S
Last Name:PAULSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1397 MANCHESTER DR NE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3882
Mailing Address - Country:US
Mailing Address - Phone:770-922-0255
Mailing Address - Fax:
Practice Address - Street 1:1397 MANCHESTER DR NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3882
Practice Address - Country:US
Practice Address - Phone:770-922-0255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0290662084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00516381BMedicaid
GAE98397Medicare UPIN
GA26BDCXLMedicare ID - Type Unspecified