Healthcare Provider Details

I. General information

NPI: 1154447423
Provider Name (Legal Business Name): KATHERINE MCWHORTER CORBETT PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 CLIFF VALLEY WAY NE
ATLANTA GA
30329-2423
US

IV. Provider business mailing address

2004 CLIFF VALLEY WAY NE
ATLANTA GA
30329-2423
US

V. Phone/Fax

Practice location:
  • Phone: 404-728-0728
  • Fax: 404-634-7802
Mailing address:
  • Phone: 404-728-0728
  • Fax: 404-634-7802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number2612
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY003033
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: