Provider Demographics
NPI:1083098065
Name:WILLIE, CERITA
Entity Type:Individual
Prefix:
First Name:CERITA
Middle Name:
Last Name:WILLIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1865 LYON AVE SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8450
Mailing Address - Country:US
Mailing Address - Phone:404-216-2296
Mailing Address - Fax:
Practice Address - Street 1:1755 THE EXCHANGE SE
Practice Address - Street 2:SUITE 330M
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-7400
Practice Address - Country:US
Practice Address - Phone:404-216-2296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No1744R1102XOther Service ProvidersSpecialistResearch Study
No174H00000XOther Service ProvidersHealth Educator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program