Provider Demographics
NPI:1447442827
Name:KATIE CLINICS, INC
Entity type:Organization
Organization Name:KATIE CLINICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:UBA
Authorized Official - Last Name:EKWENCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-948-9338
Mailing Address - Street 1:4585 AUSTELL RD
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1921
Mailing Address - Country:US
Mailing Address - Phone:770-948-9338
Mailing Address - Fax:770-948-5556
Practice Address - Street 1:4585 AUSTELL RD
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1921
Practice Address - Country:US
Practice Address - Phone:770-948-9338
Practice Address - Fax:770-948-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0387452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGROUP 7038Medicare PIN
GABDJXDMedicare PIN