Individual
DERICKA WEBSTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4690 GREENLEAF CIR SW, ATLANTA, GA 30331-7142
(167) 843-7061
Mailing address
4690 GREENLEAF CIR SW, ATLANTA, GA 30331-7142
(167) 843-7061
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
LPN080024
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPN080024
LPN
GA
Enumeration date
06/04/2018
Last updated
06/04/2018
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