Provider Demographics
NPI:1902596380
Name:GREENE, CAITLYN MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:MICHELLE
Last Name:GREENE
Suffix:
Gender:F
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 1:975 JOHNSON FERRY RD STE 400
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4736
Mailing Address - Country:US
Mailing Address - Phone:404-843-4000
Mailing Address - Fax:404-250-6701
Practice Address - Street 1:975 JOHNSON FERRY RD STE 400
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4736
Practice Address - Country:US
Practice Address - Phone:404-843-4000
Practice Address - Fax:404-250-6701
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12129363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant