=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730204330
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KATAM INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2007
-----------------------------------------------------
Last Update Date | 07/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 731 MCGILVARY ST
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-630-2105
-----------------------------------------------------
Fax | 910-630-2105
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P O BOX 64955
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-630-2105
-----------------------------------------------------
Fax | 910-630-2105
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMIN
-----------------------------------------------------
Name | MS. ARISTINE EADY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 910-630-2105
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------