Healthcare Provider Details

I. General information

NPI: 1104704154
Provider Name (Legal Business Name): KAITLIN MARIE HAFER PNP, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5080 PEACHTREE BLVD STE 100
CHAMBLEE GA
30341-2878
US

IV. Provider business mailing address

3035 LEE ST SE
SMYRNA GA
30080-4431
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-5437
  • Fax: 404-785-8053
Mailing address:
  • Phone: 770-756-4772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRN275671
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN275671
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: