Kenzie Dittmar, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

850 Charles Hardy Pkwy
Dallas, GA 30157-3163

Phone

(770) 336-8888

NPI assigned

Apr 21, 2025

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Kenzie Pierce Dittmar Professional name

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

Specialty

Physician Assistant

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aqua Dermatology of Georgia PCGroup PAC ID 6800885757, 56 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Aqua Dermatology of Georgia PC

  • Dermatology Physician
  • Marietta, GA
  • NPI 1114022167
  Medicare reassignment Care Compare group NPD
• Infinite Medical PC

  • Family Medicine Physician
  • Bristol, RI
  • NPI 1407483175

  GA, Physician Assistant

  Medicare reassignment NPD
• Dermatopathology Lab of Skin Cancer Specialists, P.C.

  • Clinical Medical Laboratory
  • Marietta, GA
  • NPI 1083044465
  NPD

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

{
    "created_epoch": "1745193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769644800000",
    "number": "1265228795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1502 N AMANDA CIR NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303293320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 CHARLES HARDY PKWY",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301573163",
            "telephone_number": "770-336-8888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10 Cloverleaf Dr",
            "address_purpose": "LOCATION",
            "city": "Cartersville",
            "state": "GA",
            "postal_code": "301202178",
            "country_code": "US",
            "telephone_number": "770-606-8026",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DITTMAR",
        "first_name": "KENZIE",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-04-21",
        "last_updated": "2026-01-29",
        "certification_date": "2026-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENZIE",
            "last_name": "DITTMAR",
            "middle_name": "PIERCE",
            "credential": "PA",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Physician Assistant in Dallas, GA
• Providers in Dallas, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.