Provider Demographics
NPI:1760501803
Name:KEITH, CATHERINE (NP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:KEITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:993 JOHNSON FERRY ROAD NE, BLDG F
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1620
Mailing Address - Country:US
Mailing Address - Phone:404-256-1727
Mailing Address - Fax:404-256-0192
Practice Address - Street 1:993 JOHNSON FERRY ROAD NE, BLDG F
Practice Address - Street 2:SUITE 210
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1620
Practice Address - Country:US
Practice Address - Phone:404-256-1727
Practice Address - Fax:404-256-0192
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR075194363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAR075194OtherLICENCE