Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kathryn Wray

Individual provider Physician Assistant · NPI 1407664238

Kathryn Wray is a Physician Assistant in Atlanta, Georgia. Qualified in 2024, 2 years ago. Practices with Northside Surgical Professional Services LLC, a 368-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
2
Licensed in
GA
In the registry since
2024
Specialties on file
3
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Practice location Address checks out

980 Johnson Fy Rd NE Ste 1040
Atlanta, GA 30342-1609
Phone: (770) 292-3490
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 616 Marriott Dr, Nashville, TN 37214-5048 — (629) 802-3000

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 12958 (GA)
Physician Assistant Taxonomy 363A00000X
Physician Assistant Taxonomy 363A00000X · Licence 1407664238 (GA)

Record details

NPI number1407664238
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedDecember 26, 2024
Last updated in NPPESMay 30, 2025
Certification dateMay 30, 2025
Mailing address616 Marriott Dr, Nashville, TN 37214-5048

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Northside Surgical Professional Services Llc — 368 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations7 on file with Medicare

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