Healthcare Provider Details

I. General information

NPI: 1053828210
Provider Name (Legal Business Name): DESTINY SATTERWHITE OTC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 01/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 PEACHTREE RD NE STE 705
ATLANTA GA
30309-1476
US

IV. Provider business mailing address

1134 MEADOWOOD LN
DOUGLASVILLE GA
30135-8811
US

V. Phone/Fax

Practice location:
  • Phone: 404-355-0743
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number072516053
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: