Provider Demographics
NPI:1285922450
Name:REBILLOT, KATHARINE PERRY (PA-C)
Entity type:Individual
Prefix:MS
First Name:KATHARINE
Middle Name:PERRY
Last Name:REBILLOT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KATHARINE
Other - Middle Name:WILSON
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:315 W PONCE DE LEON AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2400
Mailing Address - Country:US
Mailing Address - Phone:678-355-8764
Mailing Address - Fax:404-215-9222
Practice Address - Street 1:315 W PONCE DE LEON AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2400
Practice Address - Country:US
Practice Address - Phone:678-355-8764
Practice Address - Fax:404-215-9222
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
202I975855363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant