Basic Information
Provider Information
NPI: 1669404166
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KLASS
FirstName: MARKUS
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 80 JESSE HILL JR DR SE
Address2:  
City: ATLANTA
State: GA
PostalCode: 303033031
CountryCode: US
TelephoneNumber: 4047783900
FaxNumber:  
Practice Location
Address1: 69 JESSE HILL DR
Address2:  
City: ATLANTA
State: GA
PostalCode: 30345
CountryCode: US
TelephoneNumber: 4047784852
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/06/2006
LastUpdateDate: 01/16/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X052194GAY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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