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General NPI Number Information
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NPI Number | 1316325632
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Entity Type | Individual
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Provider Name | MARY-CATHERINE CHITWOOD PA-C, ATC
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Gender | Female
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Dates
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Enumeration Date | 05/07/2015
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Last Update Date | 08/27/2019
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Provider Practice Location Address
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Address Line | 2300 MANCHESTER EXPY STE 201
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City | COLUMBUS
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State | GA
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Zip | 31904-6802
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Country | US
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Telephone | 706-243-4550
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 MANCHESTER EXPY STE 201
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City | COLUMBUS
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State | GA
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Zip | 31904-6802
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Country | US
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Telephone | 706-243-4550
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT002049
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 7595
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License Number State | GA
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