Provider Demographics
NPI:1447464615
Name:BACHMEIER, KYLE CARTER (PA-C)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:CARTER
Last Name:BACHMEIER
Suffix:
Gender:M
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 1:61 WHITCHER ST NE STE 1100
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1177
Mailing Address - Country:US
Mailing Address - Phone:770-422-3290
Mailing Address - Fax:
Practice Address - Street 1:61 WHITCHER ST NE STE 1100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1177
Practice Address - Country:US
Practice Address - Phone:770-422-3290
Practice Address - Fax:770-422-0287
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004695363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I978117OtherMEDICARE PTAN