Provider Demographics
NPI:1437667896
Name:KATONGOLE, CAROLYNE N (FNP)
Entity type:Individual
Prefix:
First Name:CAROLYNE
Middle Name:N
Last Name:KATONGOLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 STERLING RIDGE CHASE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-4983
Mailing Address - Country:US
Mailing Address - Phone:617-852-1641
Mailing Address - Fax:
Practice Address - Street 1:3424 FLAT SHOALS RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-6525
Practice Address - Country:US
Practice Address - Phone:404-968-8269
Practice Address - Fax:404-968-8274
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN193652363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily