Basic Information
| Provider Information | |||||||||
| NPI: | 1528384385 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BABALIAROS | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | SHIELDS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SHIELDS | ||||||||
| OtherFirstName: | KATHERINE | ||||||||
| OtherMiddleName: | LYNN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5780 PEACHTREE DUNWOODY RD | ||||||||
| Address2: | SUITE 195 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707513600 | ||||||||
| FaxNumber: | 7703992803 | ||||||||
| Practice Location | |||||||||
| Address1: | 5780 PEACHTREE DUNWOODY RD | ||||||||
| Address2: | SUITE 195 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707513600 | ||||||||
| FaxNumber: | 7703992803 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2010 | ||||||||
| LastUpdateDate: | 09/30/2014 | ||||||||
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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 | 207V00000X | 4613 | GA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 71940 | 01 | GA | PHYSICIAN LICENSE | OTHER | 003147544C | 05 | GA | MEDICAID | 003147544D | 05 | GA | MEDICAID | 003147544A | 05 | GA | MEDICAID | 003147544B | 05 | GA | MEDICAID |