Provider Demographics
NPI:1306084835
Name:CATALYST DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:CATALYST DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CATALANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-840-8811
Mailing Address - Street 1:1247 FALLING WATER DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-2651
Mailing Address - Country:US
Mailing Address - Phone:404-840-8811
Mailing Address - Fax:
Practice Address - Street 1:1247 FALLING WATER DR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-2651
Practice Address - Country:US
Practice Address - Phone:404-840-8811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATALYST MANAGEMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041961207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
25BBFSJMedicare PIN