Provider Demographics
NPI:1962851352
Name:ALTMAN, KERI LYNN (NP-C)
Entity type:Individual
Prefix:MRS
First Name:KERI
Middle Name:LYNN
Last Name:ALTMAN
Suffix:
Gender:
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:GA
Mailing Address - Zip Code:30110-0728
Mailing Address - Country:US
Mailing Address - Phone:770-537-1234
Mailing Address - Fax:
Practice Address - Street 1:107 WEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4335
Practice Address - Country:US
Practice Address - Phone:678-390-7070
Practice Address - Fax:678-390-7071
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN213457363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1861915647OtherGROUP NPI