KATRINA D. BLACK (NPI# 1801194972) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801194972 |
| Entity Type | Individual |
| Full Name | KATRINA D. BLACK |
| Other Name | KATRINA D. BROOMFIELD |
| Credential | PA |
| Practice Address |
205 Shirley Ave Douglas GA 31533-2327 |
| Mailing Address |
Po Box 1287 Douglas GA 31534-1287 |
| Practice Telephone | 9123836966 |
| Practice Fax Number | 9123892108 |
| Mailing Telephone | 9123836966 |
| Mailing Fax Number | 9123892108 |
| Enumeration Date | 2011-03-14 |
| Last Update Date | 2011-03-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
004612 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457892077 | Katrina Black | Social Worker | 3090 N 53rd St, Milwaukee, WI 53210-1617 | 2017-03-15 |
| Street Address |
205 SHIRLEY AVE |
| City | DOUGLAS |
| State | GA |
| Zip Code | 31533-2327 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770516361 | Jeffery Thomas Winge | Emergency Medicine | 205 Shirley Ave, Douglas, GA 31533 | 2006-07-08 |
| 1023485935 | Shanda Deleice Carter | Nurse Practitioner | 205 Shirley Ave, Douglas, GA 31533-2327 | 2015-08-26 |
| 1295061208 | Caroline Lott Douglas | Physician Assistant | 205 Shirley Ave, Douglas, GA 31533-2327 | 2009-10-26 |
| 1639211956 | Coffee Regional Medical Center, Inc | Clinic/Center | 205 Shirley Ave, Douglas, GA 31533-2327 | 2007-02-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508470964 | Swain Drug Company LLC | Pharmacy | 855 Bowens Mill Rd Sw Suite E, Douglas, GA 31533 | 2020-09-03 |
| 1811528649 | Unison Behavioral Health | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 211 North Street, Douglas, GA 31533 | 2020-01-30 |
| 1952940793 | Teresa Smith | Pharmacist | 901 W Ward St, Douglas, GA 31533 | 2019-12-26 |
| 1447641048 | Jennifer Spivey | Nurse Practitioner | 326 Shirley Avenue, Douglas, GA 31533 | 2015-02-18 |
| 1972914497 | Jessica Lynne Courson | Nurse Practitioner | 903 West Ward Street, Suite B, Douglas, GA 31533 | 2014-05-19 |
| 1063840296 | South Central Primary Care Center | Clinic/Center | 303 Shirley Ave, Ste B, Douglas, GA 31533 | 2013-10-25 |
| 1336411008 | Unison Behavioral Health | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 118 Coweta Avenue South, Douglas, GA 31533 | 2012-01-27 |
| 1346482700 | V and V Clinic | Pediatrics | 1020 West Bryan Street, Douglas, GA 31533 | 2009-04-01 |
| 1063650406 | Jayla Snipes Bullock | Speech-Language Pathologist | 618 Bowens Mill Road Sw, Douglas, GA 31533 | 2009-01-22 |
| 1417112707 | Southern Community Services Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 315 S. Gaskin Ave, Douglas, GA 31533 | 2008-07-25 |
| Find all providers in zip 31533 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629456694 | Annsley Mathews Coffee | Physician Assistant | 312 Westside Dr, Douglas, GA 31533-3530 | 2015-05-11 |
| 1982610150 | Tara Roberts Spivey | Physician Assistant | 1208 Ocilla Rd, Douglas, GA 31533-2220 | 2006-07-31 |
| 1306802236 | Kimberly Lott | Physician Assistant | 100 Doctors Dr Ste G, Douglas, GA 31533-2211 | 2006-04-20 |
| 1669825725 | Allison Barnett | Physician Assistant | 700 E Center St, Douglas, WY 82633-2446 | 2016-07-13 |
| 1578919643 | Victoria Suttles White | Physician Assistant | 312 Westside Dr, Douglas, GA 31533-3530 | 2016-05-09 |
| 1962674176 | Billy Edward Roberts | Physician Assistant | 1101 Ocilla Rd Ste A, Douglas, GA 31533-2207 | 2008-03-27 |
| 1821125493 | Oscar Aguirre Jr. | Physician Assistant | 111 S 5th St, Douglas, WY 82633-2434 | 2007-02-28 |
| 1508938531 | Margaret S. Minchew | Physician Assistant | 2010 Ocilla Rd, Douglas, GA 31533-2230 | 2006-11-14 |
| 1225128754 | Sheila Sterkel | Physician Assistant | 111 S 5th St, Douglas, WY 82633-2434 | 2006-10-13 |
| 1902992555 | Lew Howard Cooksey | Physician Assistant | 111 S 5th St, Douglas, WY 82633 | 2006-10-04 |
| Find all providers in DOUGLAS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.