Healthcare Provider Details

I. General information

NPI: 1235503897
Provider Name (Legal Business Name): KATHRYN G VASIOS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN G OVINGTON PA-C

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 BORGHESE DR BLDG 2072
ROBINS AFB GA
31098-2700
US

IV. Provider business mailing address

PO BOX 30101
GREENVILLE NC
27833-0101
US

V. Phone/Fax

Practice location:
  • Phone: 478-201-4202
  • Fax:
Mailing address:
  • Phone: 202-877-4848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-14874
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: