Provider Demographics
NPI:1548535800
Name:MENEZES, KAREM VIVIAN (MD)
Entity type:Individual
Prefix:DR
First Name:KAREM
Middle Name:VIVIAN
Last Name:MENEZES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2155
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2155
Mailing Address - Country:US
Mailing Address - Phone:606-474-0669
Mailing Address - Fax:
Practice Address - Street 1:204 CANTON RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2304
Practice Address - Country:US
Practice Address - Phone:770-886-5437
Practice Address - Fax:770-886-9717
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45369208000000X
FLTRN 13410390200000X
GA81618208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100211610Medicaid
GA81618OtherSTATE LICENSE