Provider Demographics
NPI:1609274752
Name:EDDY, KAITLIN KELLY (PA)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:KELLY
Last Name:EDDY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:HINSON
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1800 HOWELL MILL RD NW
Mailing Address - Street 2:SUITE 800
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2538
Mailing Address - Country:US
Mailing Address - Phone:404-350-9853
Mailing Address - Fax:404-477-1162
Practice Address - Street 1:1800 HOWELL MILL RD NW
Practice Address - Street 2:SUITE 800
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2538
Practice Address - Country:US
Practice Address - Phone:404-350-9853
Practice Address - Fax:404-477-1162
Is Sole Proprietor?:No
Enumeration Date:2014-12-05
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003158768AMedicaid