Provider Demographics
NPI:1255521647
Name:SPRINGER, KEATRINA T (CPNP)
Entity type:Individual
Prefix:MRS
First Name:KEATRINA
Middle Name:T
Last Name:SPRINGER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:KEATRINA
Other - Middle Name:T
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:119 AMBULANCE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3857
Mailing Address - Country:US
Mailing Address - Phone:770-838-8710
Mailing Address - Fax:770-838-8563
Practice Address - Street 1:148 CLINIC AVE
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4414
Practice Address - Country:US
Practice Address - Phone:770-838-8640
Practice Address - Fax:770-838-8650
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN205796363LP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN205796OtherNP LICENSE