Basic Information
Provider Information
NPI: 1386176329
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: POLLITZER
FirstName: COLLEEN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5780 PEACHTREE DUNWOODY RD STE 300
Address2:  
City: ATLANTA
State: GA
PostalCode: 303421513
CountryCode: US
TelephoneNumber: 4043038035
FaxNumber: 4043031325
Practice Location
Address1: 11975 MORRIS RD STE 310
Address2:  
City: ALPHARETTA
State: GA
PostalCode: 300054444
CountryCode: US
TelephoneNumber: 7707520824
FaxNumber: 7707520845
Other Information
ProviderEnumerationDate: 03/29/2017
LastUpdateDate: 08/20/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/20/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X89109GAY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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