Provider Demographics
NPI:1801587225
Name:STANTON, KATHRYN GERMAIN (NP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:GERMAIN
Last Name:STANTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:COZONAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2060 LANCASTER SQ
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-6326
Mailing Address - Country:US
Mailing Address - Phone:404-919-1969
Mailing Address - Fax:
Practice Address - Street 1:3333 OLD MILTON PKWY STE 160
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-0008
Practice Address - Country:US
Practice Address - Phone:678-335-6020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA240357363LP0808X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse