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General NPI Number Information
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NPI Number | 1487865283
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Entity Type | Individual
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Provider Name | JUANITA MCKINNON LITTLE LPN
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Gender | Female
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1701 HARDEE AVE
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City | FORT MCPHERSON
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State | GA
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Zip | 30330
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Country | US
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Telephone | 404-464-0242
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Fax | 404-464-0249
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Provider Business Mailing Address
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Address Line | 561 WOODS DR NW
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City | ATLANTA
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State | GA
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Zip | 30318-6105
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Country | US
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Telephone | 404-794-7872
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LPN030849
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License Number State | GA
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