Healthcare Provider Details

I. General information

NPI: 1750574521
Provider Name (Legal Business Name): KATHARINE ARNOLD HILLIARD-YNTEMA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHARINE A HILLIARD MD

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 12/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 MELROSE AVE
DECATUR GA
30030-2849
US

IV. Provider business mailing address

123 MELROSE AVE
DECATUR GA
30030-2849
US

V. Phone/Fax

Practice location:
  • Phone: 404-285-2756
  • Fax:
Mailing address:
  • Phone: 404-285-2756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number024949
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number024949
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: