Provider Demographics
NPI:1487178893
Name:KERTSCHER, MAGDALENA (PA-C)
Entity Type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:
Last Name:KERTSCHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MAGDALENA
Other - Middle Name:EWA
Other - Last Name:PRZYMUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 COLLIER RD NW STE 2010
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1734
Mailing Address - Country:US
Mailing Address - Phone:404-355-1799
Mailing Address - Fax:404-355-4788
Practice Address - Street 1:105 COLLIER RD NW STE 2010
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1734
Practice Address - Country:US
Practice Address - Phone:404-355-1799
Practice Address - Fax:404-355-4788
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8403363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty