Provider Demographics
NPI:1902881659
Name:MAFFEI, KAREN R (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:R
Last Name:MAFFEI
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 1:1050 THOMAS AVE
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-6071
Mailing Address - Country:US
Mailing Address - Phone:706-769-1550
Mailing Address - Fax:706-769-1514
Practice Address - Street 1:1050 THOMAS AVE
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-6071
Practice Address - Country:US
Practice Address - Phone:706-769-1550
Practice Address - Fax:706-769-1514
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035943207NS0135X
GA35943207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG54714Medicare UPIN
GA07BBSDWMedicare ID - Type UnspecifiedMEDICARE INDENTIFICATION