Provider Demographics
NPI:1902864747
Name:KENNEDY, KATHERINE A (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:A
Other - Last Name:WOOLSLAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 TREE LN STE 300
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6794
Mailing Address - Country:US
Mailing Address - Phone:770-972-6464
Mailing Address - Fax:770-978-4819
Practice Address - Street 1:1800 TREE LN STE 300
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6794
Practice Address - Country:US
Practice Address - Phone:770-972-6464
Practice Address - Fax:770-978-4819
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002027363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003152721AMedicaid