Provider Demographics
NPI:1952852584
Name:KAWAMURA, CAITLIN SUSANNAH (RD, LD)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:SUSANNAH
Last Name:KAWAMURA
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:SUSANNAH
Other - Last Name:HOBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:914 COLLIER RD NW
Mailing Address - Street 2:APARTMENT 2113
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-0907
Mailing Address - Country:US
Mailing Address - Phone:404-271-7403
Mailing Address - Fax:
Practice Address - Street 1:80 JESSE HILL JR DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3031
Practice Address - Country:US
Practice Address - Phone:404-271-7403
Practice Address - Fax:404-616-2422
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004770133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered