Provider Demographics
NPI:1033647953
Name:BEBEAU, KATHERINE ANN (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:BEBEAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KALI
Other - Middle Name:
Other - Last Name:BEBEAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:ST. JOSEPH'S/ CANDLER- MANAGED CARE DEPT.
Mailing Address - Street 2:836 EAST 65TH STREET, BLDG 22
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:912-819-2622
Mailing Address - Fax:
Practice Address - Street 1:5354 REYNOLDS ST STE 518
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6012
Practice Address - Country:US
Practice Address - Phone:912-819-9650
Practice Address - Fax:912-819-9651
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA89621207V00000X
SCLL40966207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA89621OtherGA MEDICAL LICENSE