Provider Demographics
NPI:1639457716
Name:WHYTE, KARA RENEE (PA)
Entity type:Individual
Prefix:MRS
First Name:KARA
Middle Name:RENEE
Last Name:WHYTE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 PACES FERRY ROAD SE
Mailing Address - Street 2:SUITE 1-1100 (ATTN: DENISE)
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339
Mailing Address - Country:US
Mailing Address - Phone:470-271-3421
Mailing Address - Fax:
Practice Address - Street 1:2061 EXPERIMENT STATION RD STE 505
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-5327
Practice Address - Country:US
Practice Address - Phone:706-310-0324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-24
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4139363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003114542AMedicaid
GA003114542AMedicaid