Provider Demographics
NPI:1366614331
Name:GEIST, KATHLEEN TIERNEY (P,T,, OCS, COMT)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:TIERNEY
Last Name:GEIST
Suffix:
Gender:F
Credentials:P,T,, OCS, COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3351 CONNEMARA TRCE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-4846
Mailing Address - Country:US
Mailing Address - Phone:770-527-9843
Mailing Address - Fax:
Practice Address - Street 1:1441 CLIFTON RD NE RM 170
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1004
Practice Address - Country:US
Practice Address - Phone:404-712-5660
Practice Address - Fax:404-712-4130
Is Sole Proprietor?:No
Enumeration Date:2008-03-30
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005621174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist