Healthcare Provider Details

I. General information

NPI: 1689597742
Provider Name (Legal Business Name): KAITLIN SUZANNE JACOBWITH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE
ATLANTA GA
30322-1059
US

IV. Provider business mailing address

925 CANTERBURY RD NE APT 921
ATLANTA GA
30324-7207
US

V. Phone/Fax

Practice location:
  • Phone: 404-712-2000
  • Fax:
Mailing address:
  • Phone: 636-939-2515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH036387
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: