Healthcare Provider Details

I. General information

NPI: 1639534142
Provider Name (Legal Business Name): KAITLIN M SCHAFER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2015
Last Update Date: 11/15/2022
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 CAMP CREEK PKWY
EAST POINT GA
30344
US

IV. Provider business mailing address

2008 COBBLESTONE CIR NE
BROOKHAVEN GA
30319-4908
US

V. Phone/Fax

Practice location:
  • Phone: 404-344-7337
  • Fax:
Mailing address:
  • Phone: 610-416-1117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA059223
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-09396
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10397
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: