Provider Demographics
NPI:1134680119
Name:BUTTS, EMILY FAITH (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:FAITH
Last Name:BUTTS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MRS
Other - First Name:EMILY
Other - Middle Name:FAITH
Other - Last Name:WIKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:301 MEDICAL DRIVE SUITE 504
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240
Mailing Address - Country:US
Mailing Address - Phone:706-812-2655
Mailing Address - Fax:706-812-2428
Practice Address - Street 1:2200 HAMMETT RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241
Practice Address - Country:US
Practice Address - Phone:706-880-7232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-30
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN268138163W00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse