MEDICARE: MS. KAITLYN EILLEEN GREENWAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW010155	GA

General Provider Information

NPI Number	:	1730021296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAITLYN EILLEEN GREENWAY

Provider Business Mailing Address
First Line	:	3900 GEORGE BUSBEE PKWY NW APT 413
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30144-6678
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 GEORGE BUSBEE PKWY NW APT 413
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30144-6678
Country	:	US
Telephone Number	:	706-288-6965
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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Directions to “ MS. KAITLYN EILLEEN GREENWAY ” Practice Location

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