Healthcare Provider Details

I. General information

NPI: 1396331344
Provider Name (Legal Business Name): MS. KAITLYN MARIE HOOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 COLLEGE ST
MACON GA
31207-1500
US

IV. Provider business mailing address

5673 PEACHTREE DUNWOODY RD STE 330
SANDY SPRINGS GA
30342-5023
US

V. Phone/Fax

Practice location:
  • Phone: 478-301-2600
  • Fax: 478-301-2455
Mailing address:
  • Phone: 404-459-0002
  • Fax: 404-459-0003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number113347
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: