Healthcare Provider Details

I. General information

NPI: 1437112109
Provider Name (Legal Business Name): KATHERINE M. VORIS ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W WIEUCA RD NW
ATLANTA GA
30342-3223
US

IV. Provider business mailing address

215 W WIEUCA RD NW
ATLANTA GA
30342-3223
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-8983
  • Fax: 404-267-1835
Mailing address:
  • Phone: 404-252-8389
  • Fax: 404-297-1835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT001035
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: