MEDICARE: NATALIE WITTE 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	207Q00000X	Family Medicine Physician	35591	AZ
2	207QS0010X	Sports Medicine (Family Medicine) Physician	079844	GA

General Provider Information

NPI Number	:	1588622963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE WITTE M.D.

Provider Business Mailing Address
First Line	:	6 EXECUTIVE PARK DR NE STE 10
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-2224
Country	:	US
Telephone Number	:	404-321-9900
Fax Number	:	404-321-4460

Provider Business Practice Location Address
First Line	:	6 EXECUTIVE PARK DR NE STE 10
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-2224
Country	:	US
Telephone Number	:	404-321-9900
Fax Number	:	404-321-4460

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	05/01/2018

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Directions to “ NATALIE WITTE M.D.” Practice Location

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