Provider Demographics
NPI:1558868315
Name:ZAVALA, KATLYN WILL (MD)
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:WILL
Last Name:ZAVALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATLYN
Other - Middle Name:ELISE
Other - Last Name:WILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 12939
Mailing Address - Street 2:C/O CLINIC MANAGEMENT
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703
Mailing Address - Country:US
Mailing Address - Phone:706-602-7800
Mailing Address - Fax:
Practice Address - Street 1:2112 SHORTER AVE NW STE 200
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2042
Practice Address - Country:US
Practice Address - Phone:706-295-1184
Practice Address - Fax:706-236-1919
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA88052207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program