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

Kenzie Dittmar, PA

Individual provider Physician Assistant · NPI 1265228795

Kenzie Dittmar, PA is a Physician Assistant in Dallas, Georgia. Qualified in 2025, 1 year ago. Practices as a sole proprietor and works from 2 locations.

Years since qualifying
1
In the registry since
2025
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

850 Charles Hardy Pkwy
Dallas, GA 30157-3163
Phone: (770) 336-8888
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 10 Cloverleaf Dr, Cartersville, GA 30120-2178 — (770) 606-8026

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1265228795
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorYes
NPI enumeratedApril 21, 2025
Last updated in NPPESJanuary 29, 2026
Certification dateJanuary 29, 2026

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Accepts Medicare assignment Not indicated
Practice locations3 on file with Medicare

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