MEDICARE: KEYUNA F WEBSTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1982360467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEYUNA F WEBSTER

Provider Business Mailing Address
First Line	:	1072 W PEACHTREE ST NW UNIT 78858
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30357-3034
Country	:	US
Telephone Number	:	678-847-4728
Fax Number	:

Provider Business Practice Location Address
First Line	:	1012 ARDWICK CT SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30354-3653
Country	:	US
Telephone Number	:	423-454-9085
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2021
Last Update Date	:	11/09/2021

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Directions to “ KEYUNA F WEBSTER ” Practice Location

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