Healthcare Provider Details

I. General information

NPI: 1437245115
Provider Name (Legal Business Name): MARY KATHRYN FICHTINGER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SPRING ST NW STE 380
ATLANTA GA
30309-2854
US

IV. Provider business mailing address

1578 BRIDAL TRL
ROCK HILL SC
29732-2892
US

V. Phone/Fax

Practice location:
  • Phone: 770-383-1228
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-08934
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number12412
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: