Healthcare Provider Details

I. General information

NPI: 1801182928
Provider Name (Legal Business Name): LAKISHA SYMONE SUTTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 DRUID OAKS NE
ATLANTA GA
30329-3283
US

IV. Provider business mailing address

1724 DRUID OAKS NE
ATLANTA GA
30329-3283
US

V. Phone/Fax

Practice location:
  • Phone: 910-526-9167
  • Fax:
Mailing address:
  • Phone: 910-526-9167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN214010
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: