MEDICARE: MARY KATHRYN FICHTINGER PA-C

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	363A00000X	Physician Assistant	0010-08934	NC
2	363AM0700X	Medical Physician Assistant	12412	GA

General Provider Information

NPI Number	:	1437245115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY KATHRYN FICHTINGER PA-C

Provider Business Mailing Address
First Line	:	1578 BRIDAL TRL
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-2892
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 SPRING ST NW STE 380
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-2854
Country	:	US
Telephone Number	:	770-383-1228
Fax Number	:

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	03/07/2025

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