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NPI Code Detail

MEDICARE: KATHERINE LOUISE BACON

MEDICARE: KATHERINE LOUISE BACON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1902731516
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE LOUISE BACON
Provider Business Mailing Address
First Line : 568 SAINT CATHERINE CIR
Second Line :
City : RICHMOND HILL
State : GA
Zip : 31324-6520
Country : US
Telephone Number : 912-312-0294
Fax Number :
Provider Business Practice Location Address
First Line : 3001 MERCER UNIVERSITY DR
Second Line :
City : ATLANTA
State : GA
Zip : 30341-4115
Country : US
Telephone Number : 678-547-6778
Fax Number : 678-547-6202
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2026
Last Update Date : 06/15/2026

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Directions to “ KATHERINE LOUISE BACON ” Practice Location

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