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General NPI Number Information
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NPI Number | 1922755123
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Entity Type | Individual
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Provider Name | KATIE NICOLE BAVA
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Gender | Female
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Dates
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Enumeration Date | 03/07/2022
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 3000 HOSPITAL BLVD
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City | ROSWELL
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State | GA
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Zip | 30076-4915
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Country | US
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Telephone | 770-751-2505
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Fax |
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Provider Business Mailing Address
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Address Line | 5665 NEW NORTHSIDE DR STE 320
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City | ATLANTA
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State | GA
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Zip | 30328-5834
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Country | US
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Telephone | 770-874-6907
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9115736
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License Number State | FL
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