Basic Information
| Provider Information | |||||||||
| NPI: | 1912123761 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRADY | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 PROMINENCE POINT PKWY | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | CANTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301141236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707046988 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 104 PROMINENCE POINT PKWY | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | CANTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301141236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707046988 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 03/22/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 003445 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.