Healthcare Provider Details

I. General information

NPI: 1033529318
Provider Name (Legal Business Name): KATRINA BYRD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PARK PLACE SOUTH SE STE 445
ATLANTA GA
30303-2913
US

IV. Provider business mailing address

641 EDISON ST
DETROIT MI
48202-1535
US

V. Phone/Fax

Practice location:
  • Phone: 404-613-4708
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number98465
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number98465
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: