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Individual

ZACKARY JAKE WHITAKER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
47 INDIAN SPRINGS DR, FORSYTH, GA 31029-2077
(888) 728-0882
(478) 974-0110
Mailing address
234 ED TAYLOR RD, SPARKS, GA 31647-4335
(229) 392-0757

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN188133
GA
367500000X
Certified Registered Nurse Anesthetist
Primary
RN188133
GA

Other

Enumeration date
01/11/2013
Last updated
01/11/2013
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