Individual
BETTY R WICKSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
960 JOHNSON FERRY RD NE, SUITE 336, ATLANTA, GA 30342-1631
(404) 252-7400
(404) 252-1772
Mailing address
960 JOHNSON FERRY RD NE, SUITE 336, ATLANTA, GA 30342-1631
(404) 252-7400
(404) 252-1772
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
RN045532
GA
Other
Enumeration date
07/08/2006
Last updated
07/08/2007
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