Katherine Mary Siedor, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

766 Walther Rd
Suite 100
Lawrenceville, GA 30046-8764

Phone

(678) 312-9100

NPI assigned

May 21, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Mercer University School of Medicine, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Babcock Dermatology PCGroup PAC ID 7012093925, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

• Babcock Dermatology PC

  • Medical Specialty Clinic/Center
  • Atlanta, GA
  • NPI 1750565180
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1432166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432166400000",
    "number": "1285013458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 MORNINGTON DR NW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303271222",
            "telephone_number": "404-245-4409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "766 WALTHER RD",
            "address_2": "SUITE 100",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300468764",
            "telephone_number": "678-312-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIEDOR",
        "first_name": "KATHERINE",
        "middle_name": "MARY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-21",
        "last_updated": "2015-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Shriver
• Kenneth Shults Jr., R.N.
• Taryn Shumaker, CSFA
• Muhammad Kamran Siddiq, DO
• Waqar Ahmed Siddiqui
• Jon L Siegel, MD
• Robert James Siegel, MD
• Martin Robert Siegfried, M.D.,PHD.
• Victoria Sieverts, CCC,SLP
• Signature Women's Healthcare

• Medical Physician Assistant in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Medical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2015; 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.