Provider Demographics
NPI:1538242169
Name:MANSFIELD, KATHY E (MD)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:E
Last Name:MANSFIELD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:E
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:331 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-3502
Mailing Address - Country:US
Mailing Address - Phone:706-646-4543
Mailing Address - Fax:706-938-0401
Practice Address - Street 1:331 W MAIN ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3502
Practice Address - Country:US
Practice Address - Phone:706-646-4543
Practice Address - Fax:706-938-0401
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038299208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics