Healthcare Provider Details

I. General information

NPI: 1679806319
Provider Name (Legal Business Name): KATHERINE ORDONEZ-FALL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 DAWSON BLVD STE I
NORCROSS GA
30093-1259
US

IV. Provider business mailing address

7115 FAWN LAKE DR
ALPHARETTA GA
30005-3653
US

V. Phone/Fax

Practice location:
  • Phone: 770-449-5259
  • Fax: 770-449-5023
Mailing address:
  • Phone: 770-572-7440
  • Fax: 770-449-5023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7138
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: