MEDICARE: BRIAN D KATZ PAC

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
1	363AM0700X	Medical Physician Assistant	4089	GA

General Provider Information

NPI Number	:	1952618605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN D KATZ PAC

Provider Business Mailing Address
First Line	:	1121 JOHNSON FERRY RD
Second Line	:	SUITE 100
City	:	MARIETTA
State	:	GA
Zip	:	30068-5425
Country	:	US
Telephone Number	:	770-509-1025
Fax Number	:	770-509-1884

Provider Business Practice Location Address
First Line	:	3525 PIEDMONT RD NE
Second Line	:	BLDG 7-601
City	:	ATLANTA
State	:	GA
Zip	:	30305-1578
Country	:	US
Telephone Number	:	404-842-5400
Fax Number	:	404-848-8638

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2010
Last Update Date	:	09/01/2010

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