Provider Demographics
NPI:1285013458
Name:SIEDOR, KATHERINE MARY (PA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARY
Last Name:SIEDOR
Suffix:
Gender:F
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:3000 MORNINGTON DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-1222
Mailing Address - Country:US
Mailing Address - Phone:404-245-4409
Mailing Address - Fax:
Practice Address - Street 1:766 WALTHER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8764
Practice Address - Country:US
Practice Address - Phone:678-312-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical