MEDICARE: KATRINA A TOLER CERTIFIED FIRST ASSI

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	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1659990869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA A TOLER CERTIFIED FIRST ASSI

Provider Business Mailing Address
First Line	:	3301 E 1ST ST STE A
Second Line	:
City	:	VIDALIA
State	:	GA
Zip	:	30474-8674
Country	:	US
Telephone Number	:	912-537-4411
Fax Number	:	912-538-8485

Provider Business Practice Location Address
First Line	:	3301 E 1ST ST STE A
Second Line	:
City	:	VIDALIA
State	:	GA
Zip	:	30474-8674
Country	:	US
Telephone Number	:	912-537-4411
Fax Number	:	912-538-8485

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

Provider Enumeration Date	:	04/09/2020
Last Update Date	:	03/15/2021

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Directions to “ KATRINA A TOLER CERTIFIED FIRST ASSI” Practice Location

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