Provider Demographics
NPI:1447636774
Name:BATTS, KEENAN WHITESIDES (PT, DPT)
Entity type:Individual
Prefix:
First Name:KEENAN
Middle Name:WHITESIDES
Last Name:BATTS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KEENAN
Other - Middle Name:ELIZABETH
Other - Last Name:WHITESIDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2464 HOSEA L WILLIAMS DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-2743
Mailing Address - Country:US
Mailing Address - Phone:910-512-0085
Mailing Address - Fax:
Practice Address - Street 1:1365 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-778-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011966225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist