Individual
KATHRYN GRACE ENTREKIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
112 CORPORATE DR, CARROLLTON, GA 30117-2464
(770) 214-2300
(770) 214-9756
Mailing address
112 CORPORATE DR, CARROLLTON, GA 30117-2464
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
RN197971
GA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN197971
GA
Other
Enumeration date
02/04/2020
Last updated
09/01/2022
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