Healthcare Provider Details

I. General information

NPI: 1295583748
Provider Name (Legal Business Name): KATHERINE HENRY CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 ROSWELL RD STE D300
ATLANTA GA
30342-2635
US

IV. Provider business mailing address

3432 LANTERN VIEW LN
SCOTTDALE GA
30079-6814
US

V. Phone/Fax

Practice location:
  • Phone: 207-233-2757
  • Fax:
Mailing address:
  • Phone: 207-233-2757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number18908
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: