Provider Demographics
NPI:1588622963
Name:WITTE, NATALIE (MD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:WITTE
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 1:6 EXECUTIVE PARK DR NE STE 10
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2224
Mailing Address - Country:US
Mailing Address - Phone:404-321-9900
Mailing Address - Fax:404-321-4460
Practice Address - Street 1:6 EXECUTIVE PARK DR NE STE 10
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2224
Practice Address - Country:US
Practice Address - Phone:404-321-9900
Practice Address - Fax:404-321-4460
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35591207Q00000X
GA079844207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I50805Medicare UPIN
U7141ZMedicare ID - Type Unspecified