Healthcare Provider Details

I. General information

NPI: 1851296958
Provider Name (Legal Business Name): KATELYN MICHELE BERNABE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATELYN MICHELE WOODBURY

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6325 HOSPITAL PKWY
JOHNS CREEK GA
30097-5775
US

IV. Provider business mailing address

6105 IVEY HILL DR
CUMMING GA
30040-6665
US

V. Phone/Fax

Practice location:
  • Phone: 678-474-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS58367
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH035461
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: