Healthcare Provider Details

I. General information

NPI: 1467091900
Provider Name (Legal Business Name): KAITLYNN HUFSTETLER HAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 SUGARLOAF PKWY STE 800
DULUTH GA
30097-4346
US

IV. Provider business mailing address

1001 WINDY RIDGE LN SE
ATLANTA GA
30339-2404
US

V. Phone/Fax

Practice location:
  • Phone: 770-476-3005
  • Fax:
Mailing address:
  • Phone: 770-820-8397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHADS001030
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: