Provider Demographics
NPI:1124449723
Name:KURTZ, KATIE LYN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:LYN
Last Name:KURTZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:LYN
Other - Last Name:MAUZY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2020 HONEY CREEK PKWY SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2974
Mailing Address - Country:US
Mailing Address - Phone:770-929-0813
Mailing Address - Fax:770-922-8653
Practice Address - Street 1:2020 HONEY CREEK PKWY SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2974
Practice Address - Country:US
Practice Address - Phone:770-929-0813
Practice Address - Fax:770-922-8653
Is Sole Proprietor?:No
Enumeration Date:2013-12-27
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
227900000X
GA10945363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered