William G. Katibah III, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

31155 Issued in NC

Practice address

10320 Mallard Creek Rd
Suite 100
Charlotte, NC 28262-9756

Phone

(704) 517-2130

Fax

(877) 539-3581

NPI assigned

Jan 18, 2006

Last updated

Feb 4, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2014 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• William George Katibah III

  dba Mallard Creek Family Practice

  • Family Medicine Physician
  • Charlotte, NC
  • NPI 1518174820
  NPD (past) Authorized official
• Carolinas Physicians Network Inc

  dba Atrium Health Primary Care Cabarrus Family Medicine

  • Family Medicine Physician
  • Charlotte, NC
  • NPI 1144336587
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391472000000",
    "number": "1912987975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 BILLINGS PL",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280788506",
            "telephone_number": "704-517-2130",
            "fax_number": "704-626-2656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10320 MALLARD CREEK RD",
            "address_2": "SUITE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282629756",
            "telephone_number": "704-517-2130",
            "fax_number": "877-539-3581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KATIBAH",
        "first_name": "WILLIAM",
        "middle_name": "G.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-18",
        "last_updated": "2014-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "31155",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8947745",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rutvi Chetankumar Katariya, MD
• Andrew Katerakis, DDS
• Katherine S Pak, DDS PLLC
• Kathryn J Sudikoff DMD PLLC
• Kathyrn D. Jendrasik-Savitsky, DMD, PA
• Katie Blessing Center, LLC
• Katie Kickertz DDS Ms PLLC (Premier Endodontics of SouthPark)
• Ava Rose Katinas
• Bobby Kato, LPC
• Cara Deanna Kato, OTR

• Family Medicine Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.