Provider Demographics
NPI:1275342065
Name:LOCKETT, BETTY MAKA
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:MAKA
Last Name:LOCKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BELITA
Other - Middle Name:
Other - Last Name:MAKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:512 RIVER CHASE TRL
Mailing Address - Street 2:
Mailing Address - City:DULUTH, GA - US
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5385
Mailing Address - Country:US
Mailing Address - Phone:678-935-2378
Mailing Address - Fax:
Practice Address - Street 1:512 RIVER CHASE TRL
Practice Address - Street 2:
Practice Address - City:DULUTH, GA - US
Practice Address - State:GA
Practice Address - Zip Code:30096-5385
Practice Address - Country:US
Practice Address - Phone:678-935-2378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN085644164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse