Provider Demographics
NPI:1295556991
Name:PRINGLE, KATRINA (LDO)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:PRINGLE
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:MINYARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LDO
Mailing Address - Street 1:334 MARTIN DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:MILNER
Mailing Address - State:GA
Mailing Address - Zip Code:30257
Mailing Address - Country:US
Mailing Address - Phone:912-675-7831
Mailing Address - Fax:
Practice Address - Street 1:4949 BILL GARDNER PKWY
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248
Practice Address - Country:US
Practice Address - Phone:678-734-3489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO002916156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician