Healthcare Provider Details

I. General information

NPI: 1184190209
Provider Name (Legal Business Name): CAITLIN LEE PARSONS PA-C, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 MERIDIAN MARK RD STE 250
ATLANTA GA
30342-4767
US

IV. Provider business mailing address

5445 MERIDIAN MARK RD STE 250
ATLANTA GA
30342-4767
US

V. Phone/Fax

Practice location:
  • Phone: 404-255-1933
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT003455
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11172
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: