1396109740 NPI number — MS. KATHERINE GARRETSON DARNELL

Table of content: MS. KATHERINE GARRETSON DARNELL (NPI 1396109740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396109740 NPI number — MS. KATHERINE GARRETSON DARNELL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DARNELL
Provider First Name:
KATHERINE
Provider Middle Name:
GARRETSON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396109740
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
291 LITTLE PINE MOUNTAIN RD # 20695
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JASPER
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30143-7811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-316-2191
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 CREEKSIDE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODSTOCK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30188-4107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
470-798-0202
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC14762 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com