Individual provider Active NPI

Victoria Ann Kowalczyk, PA-C

  • Physician Assistant
  • Atlanta, GA
National Provider Identifier
1104658228
Registry record updated May 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
13961 Issued in GA
Practice address
1364 Clifton Rd NE
Atlanta, GA 30322-1059
Phone
(404) 712-7100
NPI assigned
Aug 16, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 13961 GA Primary

Addresses

Primary practice location

1364 Clifton Rd NE
Atlanta, GA 30322-1059

Mailing address

195 Arizona Ave NE Unit 176
Atlanta, GA 30307-2244
Phone (239) 322-6818

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260519004174 GA Practitioner - Physician Assistant 2163991167 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Emory University School of Medicine, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2201 Henderson Mill Rd NE
Atlanta, GA 30345-2711

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13961GAMDPhysician Assistant

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1723766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778716800000",
    "number": "1104658228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 ARIZONA AVE NE UNIT 176",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303072244",
            "telephone_number": "239-322-6818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1364 CLIFTON RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303221059",
            "telephone_number": "404-712-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOWALCZYK",
        "first_name": "VICTORIA",
        "middle_name": "ANN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-16",
        "last_updated": "2026-05-14",
        "certification_date": "2026-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "13961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.