Individual
KAWAJALEIN LATIC WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
101 TARA COMMONS DR, LOGANVILLE, GA 30052-8018
(678) 928-9701
Mailing address
3531 GLEN SUMMIT LN, SNELLVILLE, GA 30039-7612
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN224425
GA
Other
Enumeration date
06/01/2017
Last updated
06/01/2017
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