| Doctor Name: | KATHLEEN A GEORGIA |
| NPI Number: | 1053714576 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 085005260 |
| Business Practice Address: | 355 W Dundee Rd Suite #110 Buffalo Grove, IL - 600893500 |
| Business Phone Number: | 8475414878 |
| Business Fax Number: | |
| Mailing Address: | 2720 S Highland Ave, Apt 536 LOMBARD |
| State: | IL |
| Postal Code: | 601485302 |
| Phone Number: | 9202655763 |
| Fax Number: | |
| NPI Enumeration Date: | 09/29/2014 |
| NPI Last Update Date: | 09/29/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 085005260 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |