MEDICARE: KETEVAN MDZINARISHVILI-FIGHTMASTER AU.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	30001849	NC

General Provider Information

NPI Number	:	1396423869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KETEVAN MDZINARISHVILI-FIGHTMASTER AU.D.

Provider Business Mailing Address
First Line	:	149 PLANTATION RIDGE DR STE 140
Second Line	:
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-9175
Country	:	US
Telephone Number	:	704-360-4788
Fax Number	:	704-251-6746

Provider Business Practice Location Address
First Line	:	261 ASHELAND AVE STE 100
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28801-4055
Country	:	US
Telephone Number	:	828-492-3883
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2023
Last Update Date	:	09/02/2025

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