Provider Demographics
NPI:1063448363
Name:MEREDITH, CATHERINE M (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:MCKINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3540 COBB PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-4016
Mailing Address - Country:US
Mailing Address - Phone:770-974-3911
Mailing Address - Fax:770-405-0606
Practice Address - Street 1:3600 SANDY PLAINS RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-3020
Practice Address - Country:US
Practice Address - Phone:770-977-4547
Practice Address - Fax:770-977-8354
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051358207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000952894DMedicaid
GA08BBWPTMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
GA000952894DMedicaid