Healthcare Provider Details

I. General information

NPI: 1447162771
Provider Name (Legal Business Name): KATIE WERTS LDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4166 JIMMY LEE SMITH PKWY
HIRAM GA
30141-2647
US

IV. Provider business mailing address

4166 JIMMY LEE SMITH PKWY
HIRAM GA
30141-2647
US

V. Phone/Fax

Practice location:
  • Phone: 770-439-4230
  • Fax:
Mailing address:
  • Phone: 770-439-4230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberLDO002811
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: