BETTY R WICKSTROM (NPI# 1669405197) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669405197 |
| Entity Type | Individual |
| Full Name | BETTY R WICKSTROM |
| Credential | N.P. |
| Practice Address |
960 Johnson Ferry Rd Ne Suite 336 Atlanta GA 30342-1631 |
| Practice Telephone | 4042527400 |
| Practice Fax Number | 4042521772 |
| Mailing Telephone | 4042527400 |
| Mailing Fax Number | 4042521772 |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
RN045532 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
960 JOHNSON FERRY RD NE SUITE 336 |
| City | ATLANTA |
| State | GA |
| Zip Code | 30342-1631 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033112198 | Alan I Segal | Audiologist | 960 Johnson Ferry Rd Ne, Ste 200, Atlanta, GA 30342-1631 | 2005-05-23 |
| 1245628957 | Maryann Reuben | Specialist/Technologist, Other | 960 Johnson Ferry Rd Ne, Suite 120, Atlanta, GA 30342 | 2015-01-05 |
| 1679917835 | Comprehensive Internal Medicine At Northside | Internal Medicine | 960 Johnson Ferry Rd Ne, Suite 543, Atlanta, GA 30342-1631 | 2013-04-18 |
| 1881957553 | Allison M Sugg | Physician Assistant | 960 Johnson Ferry Rd Ne, Suite 200, Atlanta, GA 30342-1631 | 2012-06-19 |
| 1922392190 | Center for Pediatric Wellness, P.C. | Pediatrics | 960 Johnson Ferry Rd Ne, Suite 315, Atlanta, GA 30342-1631 | 2011-06-06 |
| 1780910737 | Faraa Mobini | Physician Assistant | 960 Johnson Ferry Rd Ne, Suite 200, Atlanta, GA 30342-1631 | 2009-10-27 |
| 1376779322 | Village Podiatry Group, P.C. | Podiatrist | 960 Johnson Ferry Rd Ne, Suite 310, Atlanta, GA 30342-1631 | 2009-06-04 |
| 1255597282 | Plastic Surgery Institute of Atlanta, P.C. | Plastic Surgery | 960 Johnson Ferry Rd Ne, Suite 245, Atlanta, GA 30342-1631 | 2008-07-30 |
| 1912165382 | Mervyn B Forman Md, L.l.c | Internal Medicine | 960 Johnson Ferry Rd Ne, Ste 530, Atlanta, GA 30342-1631 | 2008-06-02 |
| 1275722811 | Raymond V. Caputo, M.d.,p.c. | Dermatology | 960 Johnson Ferry Rd Ne, Suite 226, Atlanta, GA 30342-1631 | 2007-10-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144820614 | Nia Charnice Griffin | Nurse Practitioner | 5670 Peachtree Dunwoodyroad, Suite 900, Atlanta, GA 30342 | 2020-10-26 |
| 1255945184 | Jennifer Lynne Cole | Behavior Technician | 5555 Glenridge Con Suite 200, Atlanta, GA 30342 | 2020-09-08 |
| 1093336232 | Van Tran | Respiratory Therapist, Registered | 1000 Johnson Ferry Rd Ne, Atlanta, Ga 30342, Atlanta, GA 30342 | 2020-04-28 |
| 1356978340 | Twyla Douglas Jackson I | Clinical Nutrition, 1000 Johnson Ferry Rd Ne, Atlanta, GA 30342 | 2020-03-27 | |
| 1760013411 | Emily Hamm | Dietitian, Registered | 933 D Johnson Ferry Road, Suite 250, Atlanta, GA 30342 | 2020-01-31 |
| 1043855984 | Mackenzie Tucker Wayda | Registered Nurse | 1001 Johnson Ferry Rd. Ne, Atlanta, GA 30342 | 2019-11-14 |
| 1386288454 | Tiauna Lashun Cochman | Psychologist | 1307 Glenridge Dr, Sandy Springs, GA 30342 | 2019-11-01 |
| 1164074399 | Stephen J. White | Hearing Instrument Specialist | 5775 Peachtree Dunwoody Rd Suite 600 Fl. 6, Uhc Hearing, Atl., GA 30342 | 2019-07-09 |
| 1144788142 | Jaytyn LLC | Internal Medicine | 4600 Broswell Road, Atlanta, GA 30342 | 2019-03-08 |
| 1760954705 | Mishele Walker LLC | Counselor | 555 Glenridge Connector, Suite 200, Sandy Springs, GA 30342 | 2018-12-31 |
| Find all providers in zip 30342 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477154110 | Christina Danielle Palau Vaccari | Nurse Practitioner | 712 Pasley Ave Se, Atlanta, GA 30316-2158 | 2020-11-07 |
| 1386144848 | Gabrielle Nicole Stevens | Nurse Practitioner | 980 Johnson Ferry Rd Ste 900, Atlanta, GA 30342-4768 | 2018-02-20 |
| 1316451909 | Tamika Antoinette Thompson | Nurse Practitioner | 2569 Saint Paul Dr Sw, Atlanta, GA 30331-9221 | 2017-11-20 |
| 1396268819 | Erin Bremer | Nurse Practitioner | 12 Executive Park Dr Ne Fl 4, Atlanta, GA 30329-2206 | 2017-07-18 |
| 1275063513 | Dhruvangi Sharma | Nurse Practitioner | 8095 Roswell Rd, Atlanta, GA 30350-3931 | 2017-06-19 |
| 1093191249 | Sheryl Lamb | Nurse Practitioner | 455 E Ontario Ave Sw, Atlanta, GA 30310-1505 | 2015-08-10 |
| 1831584549 | Hope A Khan | Nurse Practitioner | 7101 Saint Clair Dr Ne, Atlanta, GA 30329-2679 | 2015-03-30 |
| 1669891941 | Sherly Clairvil | Nurse Practitioner | 5825 Glenridge Dr Ste 120, Atlanta, GA 30328-5387 | 2014-04-15 |
| 1770906620 | Countiss Williams | Nurse Practitioner | 3161 Howell Mill Rd Nw Ste 400, Atlanta, GA 30327-2117 | 2014-01-29 |
| 1609207208 | Bonnie Sparks | Nurse Practitioner | 1762 Clifton Road Ne, Atlanta, GA 30022 | 2013-12-06 |
| Find all providers in ATLANTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.