Provider Demographics
NPI:1144543877
Name:KURAOKA CLINIC
Entity type:Organization
Organization Name:KURAOKA CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAKI
Authorized Official - Middle Name:KURAOKA
Authorized Official - Last Name:RHEAUME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-980-0000
Mailing Address - Street 1:100 GALLERIA PARYWAY, S.E.
Mailing Address - Street 2:SUITE 660
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339
Mailing Address - Country:US
Mailing Address - Phone:770-980-0000
Mailing Address - Fax:770-217-4164
Practice Address - Street 1:100 GALLERIA PKWY SE
Practice Address - Street 2:SUITE 660
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3179
Practice Address - Country:US
Practice Address - Phone:770-980-0000
Practice Address - Fax:770-217-4164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0546572085R0204X
GA056473207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty