Basic Information
| Provider Information | |||||||||
| NPI: | 1053406777 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JAMES - PETERS | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | TERESA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 470 CHADBOURNE RD STE A | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945349620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072541770 | ||||||||
| FaxNumber: | 7072541779 | ||||||||
| Practice Location | |||||||||
| Address1: | 470 CHADBOURNE RD STE A | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945349620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072541770 | ||||||||
| FaxNumber: | 7072541779 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 06/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35180 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 24837 | AL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 63671 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | C178004 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 051512474 | 05 | AL | MEDICAID | 230152122B | 05 | GA | MEDICAID |