Provider Demographics
NPI:1154359644
Name:SOMMER, KATHERINE M (RD)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:M
Last Name:SOMMER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MRS
Other - First Name:KATHERINE
Other - Middle Name:M
Other - Last Name:SOMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:3018 N PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1711
Mailing Address - Country:US
Mailing Address - Phone:229-249-4121
Mailing Address - Fax:229-249-4031
Practice Address - Street 1:2501 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1735
Practice Address - Country:US
Practice Address - Phone:229-259-4139
Practice Address - Fax:229-259-4925
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002696133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA71BBBNJMedicare ID - Type UnspecifiedMEDICARE
GAQ13234Medicare UPIN