Provider Demographics
NPI:1134484652
Name:LYTHGOE, KATHERINE ALLYN
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ALLYN
Last Name:LYTHGOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:779 SAINT CHARLES AVE NE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-4176
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:779 SAINT CHARLES AVE NE
Practice Address - Street 2:UNIT 2
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-4176
Practice Address - Country:US
Practice Address - Phone:404-259-3778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant