Provider Demographics
NPI:1093260564
Name:KLATT, REBECA C (NP-C)
Entity Type:Individual
Prefix:
First Name:REBECA
Middle Name:C
Last Name:KLATT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MRS
Other - First Name:RITA
Other - Middle Name:REBECA
Other - Last Name:CORONADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1700 TREE LN
Mailing Address - Street 2:SUITE 490
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6782
Mailing Address - Country:US
Mailing Address - Phone:770-963-8030
Mailing Address - Fax:678-533-1575
Practice Address - Street 1:631 PROFESSIONAL DR
Practice Address - Street 2:SUITE 450
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3367
Practice Address - Country:US
Practice Address - Phone:770-963-8030
Practice Address - Fax:678-533-1575
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN212534363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health