Healthcare Provider Details

I. General information

NPI: 1134484652
Provider Name (Legal Business Name): MS. KATHERINE ALLYN LYTHGOE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

779 SAINT CHARLES AVE NE UNIT 2
ATLANTA GA
30306-4176
US

IV. Provider business mailing address

779 SAINT CHARLES AVE NE UNIT 2
ATLANTA GA
30306-4176
US

V. Phone/Fax

Practice location:
  • Phone: 404-259-3778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: