Provider Demographics
NPI:1376068668
Name:WARD, KATINA DENISE (RN)
Entity Type:Individual
Prefix:MS
First Name:KATINA
Middle Name:DENISE
Last Name:WARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 WILDFLOWER RD
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GA
Mailing Address - Zip Code:30273-2453
Mailing Address - Country:US
Mailing Address - Phone:706-992-5564
Mailing Address - Fax:
Practice Address - Street 1:2591 CANDLER RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-6502
Practice Address - Country:US
Practice Address - Phone:678-209-2710
Practice Address - Fax:678-212-6304
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN1657772080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics