Provider Demographics
NPI:1841739307
Name:FREEMAN, KAITLYN MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:MARIE
Last Name:FREEMAN
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 1:135 GROGANS LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-3115
Mailing Address - Country:US
Mailing Address - Phone:320-290-5699
Mailing Address - Fax:
Practice Address - Street 1:993 JOHNSON FY RD NE STE F210
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1688
Practice Address - Country:US
Practice Address - Phone:404-256-1727
Practice Address - Fax:404-252-3591
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT006305225X00000X
GA10860363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist