Provider Demographics
NPI:1821173808
Name:KATNER, HAROLD P (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:P
Last Name:KATNER
Suffix:
Gender:M
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:PO BOX 4947
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-4947
Mailing Address - Country:US
Mailing Address - Phone:478-301-2362
Mailing Address - Fax:478-301-2272
Practice Address - Street 1:707 PINE STREET
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201
Practice Address - Country:US
Practice Address - Phone:478-301-5801
Practice Address - Fax:478-301-5812
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028021207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000309878BMedicaid
GA110188118OtherRAILROAD MEDICARE
GA000309878BMedicaid
GA110188118OtherRAILROAD MEDICARE
11BDQKJMedicare ID - Type Unspecified