Kathryn Grace Entrekin | NPI 1093346470

Key facts

NPI: 1093346470
Entity type: Individual (NPI type 1)
Primary specialty: Psychiatric/Mental Health Nurse Practitioner 363LP0808X
License: RN197971 (GA)
Practice address: 112 Corporate Dr
Carrollton, GA 30117-2464
Phone: (770) 214-2300
Fax: (770) 214-9756
NPI assigned: Feb 4, 2020
Sex: Female
Sole proprietor: Yes

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Dr Mahaveer Vakharia MD PC Psychiatry Physician · Powder Springs, GA · NPI 1871739680

Medicare reassignment Care Compare group NPD GA
West Cobb Medical Associates, LLC Internal Medicine Physician · Lithia Springs, GA · NPI 1740454099

NPD (past)

Medicare Care Compare profile

Specialty: Psychiatry
Education: Other, 2021
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Telehealth: Offers telehealth services
Group practices: Dr Mahaveer Vakharia MD PC (4 clinicians)

Practice addresses (Care Compare)

4171 Marietta St
Suite 200
Powder Springs, GA 30127-2696
Phone (770) 943-8701

Medicare participation

Medicare fee-for-service enrollment: Enrolled in GA
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20220128001628	GA	Practitioner - Psychiatry	3870985666	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
RN197971	GA	MD	Child & Adolescent Psychiatric/Mental Health Registered Nurse

Practice roles

Organization	Specialty	Status	New patients
Dr Mahaveer Vakharia MD PC		Current since Nov 18, 2021	Accepting new patients
West Cobb Medical Associates, LLC		Past since Nov 18, 2021	Accepting new patients

Locations

112 Corporate Dr
Carrollton, GA 30117
Phone (770) 214-2300

4171 Marietta St
Ste 200
Powder Springs, GA 30127
Phone (770) 222-8702

Interoperability endpoints

FHIR API: https://api.platform.athenahealth.com/5606/brand/1/csg/1/fhir/r4

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Child & Adolescent Psychiatric/Mental Health Registered Nurse	163WP0807X	RN197971	GA
Psychiatric/Mental Health Nurse Practitioner	363LP0808X	RN197971	GA	Yes

Addresses

Primary practice location

112 Corporate Dr
Carrollton, GA 30117-2464

Mailing address

112 Corporate Dr
Carrollton, GA 30117-2464

Other providers in Carrollton, GA

All providers in Carrollton, GA · Psychiatric/Mental Health Nurse Practitioner in Georgia

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 1, 2022. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.