Healthcare Provider Details

I. General information

NPI: 1427247402
Provider Name (Legal Business Name): KATHERINE FRY HIDI D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHERINE LYNN FRY D.M.D.

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3065 AKERS MILL RD SE STE 225
ATLANTA GA
30339-3124
US

IV. Provider business mailing address

3065 AKERS MILL RD SE STE 225
ATLANTA GA
30339-3124
US

V. Phone/Fax

Practice location:
  • Phone: 678-990-3363
  • Fax:
Mailing address:
  • Phone: 205-901-4585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number5473
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number13702
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: