Provider Demographics
NPI:1225401839
Name:WHITE, NAKEYA S
Entity Type:Individual
Prefix:
First Name:NAKEYA
Middle Name:S
Last Name:WHITE
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 1:5301 FAIRINGTON CLUB DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-5667
Mailing Address - Country:US
Mailing Address - Phone:404-946-0186
Mailing Address - Fax:404-946-0180
Practice Address - Street 1:3379 PEACHTREE RD NE STE 555
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1418
Practice Address - Country:US
Practice Address - Phone:404-946-0186
Practice Address - Fax:404-946-0180
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171095LGB251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health