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Individual

MRS. KELLY RAE PRATER WHITMORE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
P.T.

Contact information

Practice address
394 S ALEXANDER CREEK RD, NEWNAN, GA 30263-4132
(678) 416-2472
(678) 423-5059
Mailing address
925 N POINT PKWY, STE 130, ALPHARETTA, GA 30005-5211
(770) 740-1860
(678) 347-2104

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3260
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000837449B
GA
01
323515
WELLCARE NUMBER
GA
01
3260
PT LICENSE NUMBER
GA
Enumeration date
10/15/2006
Last updated
12/13/2017
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