Provider Demographics
NPI:1568545473
Name:PAGE, KATHRYN (MD)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:
Last Name:PAGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2938 HERITAGE PL NE STE A
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-7209
Mailing Address - Country:US
Mailing Address - Phone:478-453-0453
Mailing Address - Fax:478-452-2698
Practice Address - Street 1:2938 HERITAGE PL NE STE A
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-7209
Practice Address - Country:US
Practice Address - Phone:478-453-0453
Practice Address - Fax:478-452-2698
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019516208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000262996HMedicaid