Individual
MRS. JUANITA D WYATT-HATHAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5445 MERIDIAN MARKS RD NE, SUITE 350, ATLANTA, GA 30342-4763
(404) 252-5196
(404) 252-2414
Mailing address
5780 PEACHTREE DUNWOODY ROAD, SUITE 300, ATLANTA, GA 30342-1513
(404) 303-1224
(404) 303-1325
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
042776
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000733323F
—
GA
05
—
000733323G
—
GA
Enumeration date
09/20/2006
Last updated
08/12/2013
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