Healthcare Provider Details

I. General information

NPI: 1700943941
Provider Name (Legal Business Name): CATRECHA ANDERSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 COLLIER RD NW STE 2000
ATLANTA GA
30309-1734
US

IV. Provider business mailing address

5979 DESERT STORM AVE C/O A SHAU VALLEY CLINIC
FORT CAMPBELL KY
42223-5585
US

V. Phone/Fax

Practice location:
  • Phone: 404-350-1122
  • Fax:
Mailing address:
  • Phone: 270-412-3535
  • Fax: 270-461-4598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5128
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: