Healthcare Provider Details

I. General information

NPI: 1316262876
Provider Name (Legal Business Name): HARITHA KATAKAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2010
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE
ATLANTA GA
30322-1059
US

IV. Provider business mailing address

1364 CLIFTON RD BOX M7
ATLANTA GA
30322-0001
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-5334
  • Fax: 404-778-4181
Mailing address:
  • Phone: 404-778-6382
  • Fax: 404-778-4181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number72964
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: