Active NPI
Kathryn Ann Thatcher
- Physician Assistant
- Statesboro, GA
National Provider Identifier
1164530069
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 004559
- Practice address
- 4002 Forest Dr
Statesboro, GA 30460-0001 - Phone
- (912) 478-5641
- NPI assigned
- Aug 29, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 004559 | GA | Primary |
Addresses
Primary practice location
4002 Forest Dr
Statesboro, GA 30460-0001
Mailing address
PO Box 8043
Statesboro, GA 30460-8043
Phone (912) 478-5641
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 161445499A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004559 | GA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312416000000",
"number": "1164530069",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8043",
"city": "STATESBORO",
"state": "GA",
"postal_code": "304608043",
"telephone_number": "912-478-5641"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4002 FOREST DR",
"city": "STATESBORO",
"state": "GA",
"postal_code": "304600001",
"telephone_number": "912-478-5641"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THATCHER",
"first_name": "KATHRYN",
"middle_name": "ANN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-29",
"last_updated": "2011-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "004559",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "161445499A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Statesboro, GA
- Technical Diagnostic Imaging, LLC
- John Monroe Templeton Jr., DC
- Rachael Anne Templeton, D.C.
- Tennessee Physician Services, LLC
- Timothy R Thaller, MD
- THCH Personal Care
- The Neurological Center of East Georgia PC
- The Neurological Institute of Savannah & Center for Spine P C
- The Speech Path of Statesboro, PC
- The Urgent Care Center of Richmond Hill, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.