Provider Demographics
NPI:1033954870
Name:KRAUSE, EMILY T
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:T
Last Name:KRAUSE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 DUNWOODY TRL NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-2705
Mailing Address - Country:US
Mailing Address - Phone:404-323-7894
Mailing Address - Fax:
Practice Address - Street 1:4441 ATLANTA RD SE STE 312
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6443
Practice Address - Country:US
Practice Address - Phone:470-956-4219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
GA12393363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant