Healthcare Provider Details

I. General information

NPI: 1154575520
Provider Name (Legal Business Name): HEE JIN CAYETANO PA-C, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

663 LANIER PARK DR
GAINESVILLE GA
30501-2059
US

IV. Provider business mailing address

663 LANIER PARK DR
GAINESVILLE GA
30501-2059
US

V. Phone/Fax

Practice location:
  • Phone: 678-450-0202
  • Fax: 678-971-6065
Mailing address:
  • Phone: 678-450-0202
  • Fax: 678-971-6065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberLD003056
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD003056
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9851
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: