Basic Information
| Provider Information | |||||||||
| NPI: | 1447464615 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BACHMEIER | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | CARTER | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 61 WHITCHER ST NE STE 1100 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300601177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704223290 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 61 WHITCHER ST NE STE 1100 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300601177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704223290 | ||||||||
| FaxNumber: | 7704220287 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 07/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 004695 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AS0400X | 004695 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363A00000X | 004695 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 202I978117 | 01 | GA | MEDICARE PTAN | OTHER |