Provider Demographics
NPI:1871151621
Name:FISHER, KATHERINE ANNE (ATC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANNE
Last Name:FISHER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6440 QUEENS COURT TRCE
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-7227
Mailing Address - Country:US
Mailing Address - Phone:404-518-0801
Mailing Address - Fax:
Practice Address - Street 1:6440 QUEENS COURT TRCE
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-7227
Practice Address - Country:US
Practice Address - Phone:404-518-0801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X2255A2300X
BOC3667192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
BOC366719OtherBOC