MEDICARE: DR. TARA KATTINE 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	207R00000X	Internal Medicine Physician	043671	GA
2	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	043671	GA
3	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	19771	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700071784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TARA KATTINE M.D.

Provider Business Mailing Address
First Line	:	3614 J DEWEY GRAY CIR STE B
Second Line	:	2ND FLOOR
City	:	AUGUSTA
State	:	GA
Zip	:	30909-6512
Country	:	US
Telephone Number	:	706-504-4651
Fax Number	:	706-504-4639

Provider Business Practice Location Address
First Line	:	3614 J DEWEY GRAY CIR STE B
Second Line	:	2ND FLOOR
City	:	AUGUSTA
State	:	GA
Zip	:	30909-6512
Country	:	US
Telephone Number	:	706-504-4651
Fax Number	:	706-504-4639

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

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	05/19/2015

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Directions to “ DR. TARA KATTINE M.D.” Practice Location

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