Provider Demographics
NPI:1407377666
Name:EVERETT, ANITA
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:
Last Name:EVERETT
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 1:4644 POWDER SPRINGS DALLAS RD UNIT 2211
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-7721
Mailing Address - Country:US
Mailing Address - Phone:770-655-8749
Mailing Address - Fax:
Practice Address - Street 1:5815 WEBB FOREST CT
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-9061
Practice Address - Country:US
Practice Address - Phone:770-655-8749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty