Healthcare Provider Details

I. General information

NPI: 1801645262
Provider Name (Legal Business Name): CAITLYN YAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3672 MARATHON CIR # 200
AUSTELL GA
30106-6821
US

IV. Provider business mailing address

1731 OAKBROOK LN NW
KENNESAW GA
30152-4561
US

V. Phone/Fax

Practice location:
  • Phone: 770-944-3303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: