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General NPI Number Information
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NPI Number | 1376195677
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Entity Type | Individual
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Provider Name | KATHERINE PROTOPAPADAKIS PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/16/2019
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Last Update Date | 10/18/2021
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Provider Practice Location Address
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Address Line | 1280 HIGHWAY 74 S STE 100
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-3077
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Country | US
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Telephone | 678-961-5150
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 OAKLEY INDUSTRIAL BLVD APT 1101
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City | FAIRBURN
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State | GA
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Zip | 30213-6013
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Country | US
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Telephone | 786-510-7338
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9111917
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10142
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License Number State | GA
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