MEDICARE: DR. MARY KATHERINE MCDONALD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	28536	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00194880	OTHER		MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	4097642	OTHER	TN	BLUE CROSS AND BLUE SHIELD

General Provider Information

NPI Number	:	1396710794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY KATHERINE MCDONALD M.D.

Provider Business Mailing Address
First Line	:	PO BOX 80883
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30608-0883
Country	:	US
Telephone Number	:	706-549-0151
Fax Number	:	706-993-3343

Provider Business Practice Location Address
First Line	:	5211 HIGHWAY 153
Second Line	:	SUITE M
City	:	HIXSON
State	:	TN
Zip	:	37343-4956
Country	:	US
Telephone Number	:	423-648-7667
Fax Number	:	423-648-6279

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2006
Last Update Date	:	01/25/2016

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