Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath |
NPI | 1972989762 |
---|---|
Provider Name | Dr. Karen Maxine Witty |
First Address | Rex, GA 30273-2736 |
Second Address | Atlanta, GA 30303-3304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2015 |
Last Update Date | 22/03/2016 |