Provider Demographics
NPI:1639534142
Name:SCHAFER, KAITLIN M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KAITLIN
Middle Name:M
Last Name:SCHAFER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 COBBLESTONE CIR NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-4908
Mailing Address - Country:US
Mailing Address - Phone:610-416-1117
Mailing Address - Fax:
Practice Address - Street 1:3515 CAMP CREEK PKWY
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344
Practice Address - Country:US
Practice Address - Phone:404-344-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059223363A00000X
NC0010-09396363A00000X
GA10397363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant