Basic Information
| Provider Information | |||||||||
| NPI: | 1588259824 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ECIE | ||||||||
| FirstName: | KAITLIN | ||||||||
| MiddleName: | BITTINGER | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1835 SAVOY DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303411071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6782889555 | ||||||||
| FaxNumber: | 6782889556 | ||||||||
| Practice Location | |||||||||
| Address1: | 228 RIVERSTONE DR | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301145256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704791870 | ||||||||
| FaxNumber: | 7704799705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2021 | ||||||||
| LastUpdateDate: | 06/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN213534 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 003248273A | 05 | GA | MEDICAID | G25424A | 01 | GA | MEDICARE | OTHER |