Healthcare Provider Details

I. General information

NPI: 1922755123
Provider Name (Legal Business Name): KATIE NICOLE BAVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 NORTHSIDE FORSYTH DR
CUMMING GA
30041-7659
US

IV. Provider business mailing address

20 BURTON HILLS BLVD
NASHVILLE TN
37215-6197
US

V. Phone/Fax

Practice location:
  • Phone: 770-844-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13574
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9115736
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: