=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811061021
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW JUSTIN KRITZER FNP-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2006
-----------------------------------------------------
Last Update Date | 10/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1504 N THORNTON AVE STE 103
-----------------------------------------------------
City | DALTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30720-8394
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-962-3642
-----------------------------------------------------
Fax | 770-962-3643
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 455 PHILIP BLVD STE 140
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30046-8768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-962-3642
-----------------------------------------------------
Fax | 770-962-3643
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 5009874
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 4045
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | GAA-NP002022
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------