Basic Information
| Provider Information | |||||||||
| NPI: | 1831862325 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KATUREEBE MEDICAL ASSOCIATES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 290 BLUE SPRUCE TRL | ||||||||
| Address2: | |||||||||
| City: | LILBURN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300477060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6179016120 | ||||||||
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| Practice Location | |||||||||
| Address1: | 290 BLUE SPRUCE TRL | ||||||||
| Address2: | |||||||||
| City: | LILBURN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300477060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6179016120 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2021 | ||||||||
| LastUpdateDate: | 07/29/2021 | ||||||||
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| AuthorizedOfficialLastName: | BANEGURA | ||||||||
| AuthorizedOfficialFirstName: | GLENN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6179016120 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 07/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.