Provider Demographics
NPI:1306911797
Name:GARNER-KUADA, CATHERINE DANIELLE (MD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:DANIELLE
Last Name:GARNER-KUADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 MARSHALL PL
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-5119
Mailing Address - Country:US
Mailing Address - Phone:601-981-3004
Mailing Address - Fax:601-510-2105
Practice Address - Street 1:1809 MARSHALL PL
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213
Practice Address - Country:US
Practice Address - Phone:601-981-3004
Practice Address - Fax:601-510-2105
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18317207Q00000X
LAMD.206740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09684292Medicaid
MSH76788Medicare UPIN