Healthcare Provider Details

I. General information

NPI: 1750833232
Provider Name (Legal Business Name): CARRIE LEIGH WHITEHEAD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6228 BRADLEY PARK DR. SUITE A
COLUMBUS GA
31904
US

IV. Provider business mailing address

6228 BRADLEY PARK DR STE A
COLUMBUS GA
31904-3605
US

V. Phone/Fax

Practice location:
  • Phone: 706-617-4031
  • Fax:
Mailing address:
  • Phone: 706-322-1486
  • Fax: 706-324-3419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN 169401
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: