Healthcare Provider Details

I. General information

NPI: 1811515539
Provider Name (Legal Business Name): KIMBERLY CAITO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6849 PEACHTREE DUNWOODY RD UNIT 1
ATLANTA GA
30328-1608
US

IV. Provider business mailing address

2472 JETT FERRY RD STE 400-197
ATLANTA GA
30338-3059
US

V. Phone/Fax

Practice location:
  • Phone: 678-691-2206
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: