Provider Demographics
NPI:1518069574
Name:MCGAHA, JULIETTE WILKINSON (RN)
Entity Type:Individual
Prefix:
First Name:JULIETTE
Middle Name:WILKINSON
Last Name:MCGAHA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 RIVERBROOK RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-2921
Mailing Address - Country:US
Mailing Address - Phone:404-730-1650
Mailing Address - Fax:
Practice Address - Street 1:475 FAIRBURN RD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-1907
Practice Address - Country:US
Practice Address - Phone:404-691-9627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA092487163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse