Basic Information
| Provider Information | |||||||||
| NPI: | 1174535629 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LANDMAN | ||||||||
| FirstName: | KEREN | ||||||||
| MiddleName: | ZOHAR | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1510 HUDSON BRIDGE RD | ||||||||
| Address2: | C/O CHILDREN'S HEALTHCARE OF ATLA | ||||||||
| City: | STOCKBRIDGE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302815020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047858660 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1510 HUDSON BRIDGE RD | ||||||||
| Address2: | C/O CHILDREN'S HEALTHCARE OF ATLA | ||||||||
| City: | STOCKBRIDGE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302815020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047858660 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 05/24/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 072958 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207R00000X | 072958 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 072958 | GA | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.