Basic Information
| Provider Information | |||||||||
| NPI: | 1952618605 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KATZ | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1121 JOHNSON FERRY RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300685425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705091025 | ||||||||
| FaxNumber: | 7705091884 | ||||||||
| Practice Location | |||||||||
| Address1: | 3525 PIEDMONT RD NE | ||||||||
| Address2: | BLDG 7-601 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303051578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048425400 | ||||||||
| FaxNumber: | 4048488638 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2010 | ||||||||
| LastUpdateDate: | 09/01/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 4089 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.