Individual
MARY KATHERINE FENNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
993 JOHNSON FERRY RD STE F210, ATLANTA, GA 30342-1688
(404) 256-1727
Mailing address
993 JOHNSON FERRY RD STE F210, ATLANTA, GA 30342-1688
(404) 256-1727
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13196
GA
208200000X
Plastic Surgery Physician
Primary
13196
GA
Other
Enumeration date
06/17/2025
Last updated
04/22/2026
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