Basic Information
| Provider Information | |||||||||
| NPI: | 1376137570 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DENNIS | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | ELYSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 368 DUMAS RD | ||||||||
| Address2: | |||||||||
| City: | FORSYTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310298793 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4789573126 | ||||||||
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| Practice Location | |||||||||
| Address1: | 130 N LEE ST STE 124-130 | ||||||||
| Address2: | |||||||||
| City: | FORSYTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310292122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4789746080 | ||||||||
| FaxNumber: | 4789749002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2021 | ||||||||
| LastUpdateDate: | 04/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN239685 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.