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General NPI Number Information
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NPI Number | 1356996748
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Entity Type | Individual
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Provider Name | KATRINA NICOLE LIKES FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/02/2019
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Last Update Date | 10/01/2019
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Provider Practice Location Address
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Address Line | 2965 JOHNSON FERRY RD STE D
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City | MARIETTA
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State | GA
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Zip | 30062-8364
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Country | US
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Telephone | 770-998-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 3995 JEFFERSON TOWNSHIP PKWY
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City | MARIETTA
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State | GA
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Zip | 30066-1703
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Country | US
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Telephone | 815-566-1007
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN238385
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License Number State | GA
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