Healthcare Provider Details

I. General information

NPI: 1649108572
Provider Name (Legal Business Name): TATENDA KATSANDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 PATRICK HENRY PKWY STE 150
MCDONOUGH GA
30253-4326
US

IV. Provider business mailing address

1400 JR GRANT BLVD APT 1407
MCDONOUGH GA
30253-8440
US

V. Phone/Fax

Practice location:
  • Phone: 770-462-4440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14041
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: