Provider Demographics
NPI:1326363441
Name:SUSAN KATRIN PH.D., PC
Entity Type:Organization
Organization Name:SUSAN KATRIN PH.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KATRIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD , PC
Authorized Official - Phone:678-637-7535
Mailing Address - Street 1:2801 BUFORD HWY NE
Mailing Address - Street 2:SUITE 505
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2149
Mailing Address - Country:US
Mailing Address - Phone:678-637-7535
Mailing Address - Fax:404-315-9235
Practice Address - Street 1:2801 BUFORD HWY NE
Practice Address - Street 2:SUITE 505
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2149
Practice Address - Country:US
Practice Address - Phone:678-637-7535
Practice Address - Fax:404-315-9235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1058261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA62TCCHZMedicare UPIN