Provider Demographics
NPI:1528154846
Name:KLOTZ, KATHLEEN L (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:L
Last Name:KLOTZ
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 1:3542 OLD MILTON PARKWAY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005
Mailing Address - Country:US
Mailing Address - Phone:678-893-0884
Mailing Address - Fax:678-893-0887
Practice Address - Street 1:3542 OLD MILTON PARKWAY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005
Practice Address - Country:US
Practice Address - Phone:678-893-0884
Practice Address - Fax:678-893-0887
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0356722084N0400X
KYTP3642084N0400X
KY495432084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
13BDCDBMedicare ID - Type Unspecified
F32427Medicare UPIN
KYK210330Medicare PIN