Healthcare Provider Details

I. General information

NPI: 1538242169
Provider Name (Legal Business Name): KATHY E MANSFIELD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHY E DAVIS MD

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 W MAIN ST
THOMASTON GA
30286-3502
US

IV. Provider business mailing address

331 W MAIN ST
THOMASTON GA
30286-3502
US

V. Phone/Fax

Practice location:
  • Phone: 706-646-4543
  • Fax: 706-938-0401
Mailing address:
  • Phone: 706-646-4543
  • Fax: 706-938-0401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number038299
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: