Provider Demographics
NPI:1548372949
Name:MAYO, KATHY D (MD)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:D
Last Name:MAYO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 W H SMITH BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3752
Mailing Address - Country:US
Mailing Address - Phone:252-758-6080
Mailing Address - Fax:252-758-0009
Practice Address - Street 1:707 W H SMITH BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3752
Practice Address - Country:US
Practice Address - Phone:252-758-6080
Practice Address - Fax:252-758-0009
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC343932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8955248Medicaid
2184243BMedicare ID - Type Unspecified
NC8955248Medicaid