Healthcare Provider Details

I. General information

NPI: 1477131134
Provider Name (Legal Business Name): FAWAZ KATMEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WHETSTONE PL STE 105
ST AUGUSTINE FL
32086-5775
US

IV. Provider business mailing address

PO BOX 740861
ATLANTA GA
30374-0861
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-3777
  • Fax: 904-824-6050
Mailing address:
  • Phone:
  • Fax: 904-819-4906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME167408
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: