Provider Demographics
NPI:1750574521
Name:HILLIARD-YNTEMA, KATHARINE ARNOLD (MD)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:ARNOLD
Last Name:HILLIARD-YNTEMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHARINE
Other - Middle Name:A
Other - Last Name:HILLIARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:123 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2849
Mailing Address - Country:US
Mailing Address - Phone:404-285-2756
Mailing Address - Fax:
Practice Address - Street 1:123 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2849
Practice Address - Country:US
Practice Address - Phone:404-285-2756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0249492084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00473426AMedicaid
26BDDBJMedicare PIN