Provider Demographics
NPI:1104704154
Name:HAFER, KAITLIN MARIE (PNP, DNP)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:MARIE
Last Name:HAFER
Suffix:
Gender:F
Credentials:PNP, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 LEE ST SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-4431
Mailing Address - Country:US
Mailing Address - Phone:770-756-4772
Mailing Address - Fax:
Practice Address - Street 1:5080 PEACHTREE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-2878
Practice Address - Country:US
Practice Address - Phone:404-785-5437
Practice Address - Fax:404-785-8053
Is Sole Proprietor?:No
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN275671208000000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics