Provider Demographics
NPI:1407996713
Name:DOANE, KATHY BERDECIA (PHARMD, RPH, RDN)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:BERDECIA
Last Name:DOANE
Suffix:
Gender:F
Credentials:PHARMD, RPH, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-4450
Mailing Address - Country:US
Mailing Address - Phone:770-836-0770
Mailing Address - Fax:
Practice Address - Street 1:1128 S PARK ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4450
Practice Address - Country:US
Practice Address - Phone:770-836-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1443133N00000X, 133NN1002X
MA2762133V00000X
MA236242183500000X
GARPH0341701835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No183500000XPharmacy Service ProvidersPharmacist