Provider Demographics
NPI:1639758311
Name:ERVIN, KAITLIN Z (MD)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:Z
Last Name:ERVIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 N SHALLOWFORD RD STE B
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6476
Mailing Address - Country:US
Mailing Address - Phone:404-778-6920
Mailing Address - Fax:404-778-6811
Practice Address - Street 1:4500 N SHALLOWFORD RD STE B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6476
Practice Address - Country:US
Practice Address - Phone:404-727-8868
Practice Address - Fax:404-727-1174
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program