Provider Demographics
NPI:1932409166
Name:MINTON, KERI L (PA)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:L
Last Name:MINTON
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:69 JESSE HILL JR DR SE
Mailing Address - Street 2:ROOM 314A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-3033
Mailing Address - Country:US
Mailing Address - Phone:404-251-8916
Mailing Address - Fax:
Practice Address - Street 1:100 PROFESSIONAL PARK
Practice Address - Street 2:SUITE 310
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3874
Practice Address - Country:US
Practice Address - Phone:770-812-5902
Practice Address - Fax:770-812-5903
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2014-08-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA005947363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA005947OtherGA. LICENSE