Individual
KETTIA MATHURIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
5667 PEACHTREE DUNWOODY RD STE 260, ATLANTA, GA 30342-1714
(404) 255-1030
(678) 843-6619
Mailing address
5667 PEACHTREE DUNWOODY RD STE 260, ATLANTA, GA 30342-1714
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN195570
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003202496A
—
GA
Enumeration date
06/30/2017
Last updated
03/22/2021
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