Healthcare Provider Details

I. General information

NPI: 1083166110
Provider Name (Legal Business Name): PREETHY LETISHA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FY RD NE
ATLANTA GA
30342-1606
US

IV. Provider business mailing address

1000 JOHNSON FY RD NE
ATLANTA GA
30342-1606
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-8917
  • Fax: 678-293-5450
Mailing address:
  • Phone: 404-851-8917
  • Fax: 678-293-5450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN179310
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: