Provider Demographics
NPI:1265796197
Name:EMBRY, KATHERINE ANNA (MD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:ANNA
Last Name:EMBRY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 2510
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-2510
Mailing Address - Country:US
Mailing Address - Phone:706-922-8251
Mailing Address - Fax:706-922-6695
Practice Address - Street 1:105 E HUGH ST
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-2925
Practice Address - Country:US
Practice Address - Phone:803-279-6800
Practice Address - Fax:803-279-2876
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2024-05-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC40160207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC40160OtherSC MEDICAL LICENSE
SC401602Medicaid
SCFE6413594OtherDEA