Provider Demographics
NPI:1477313419
Name:DAJUSTE, KETSIA
Entity Type:Individual
Prefix:
First Name:KETSIA
Middle Name:
Last Name:DAJUSTE
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 1:1496 CASTLEBERRY DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-5069
Mailing Address - Country:US
Mailing Address - Phone:678-200-7938
Mailing Address - Fax:
Practice Address - Street 1:1496 CASTLEBERRY DR
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-5069
Practice Address - Country:US
Practice Address - Phone:678-200-7938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program