Healthcare Provider Details

I. General information

NPI: 1063448363
Provider Name (Legal Business Name): CATHERINE M MEREDITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE MCKINNEY

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 SANDY PLAINS RD
MARIETTA GA
30066-3020
US

IV. Provider business mailing address

3540 COBB PKWY NW
ACWORTH GA
30101-4016
US

V. Phone/Fax

Practice location:
  • Phone: 770-977-4547
  • Fax: 770-977-8354
Mailing address:
  • Phone: 770-974-3911
  • Fax: 770-405-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number051358
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: