Healthcare Provider Details

I. General information

NPI: 1033738349
Provider Name (Legal Business Name): KATHRYN IWASAKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 08/23/2023
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5665 PEACHTREE DUNWOODY RD
ATLANTA GA
30342-1764
US

IV. Provider business mailing address

7250 AMBERLEIGH WAY
DULUTH GA
30097-1870
US

V. Phone/Fax

Practice location:
  • Phone: 678-843-7001
  • Fax:
Mailing address:
  • Phone: 770-232-9985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number9758
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: