Healthcare Provider Details

I. General information

NPI: 1689690075
Provider Name (Legal Business Name): ALEXANDRA WHIDDON MSRNCSNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 WINN WAY STE 221
DECATUR GA
30030-1723
US

IV. Provider business mailing address

465 WINN WAY STE 221
DECATUR GA
30030-1723
US

V. Phone/Fax

Practice location:
  • Phone: 404-292-3810
  • Fax: 404-292-3848
Mailing address:
  • Phone: 404-292-3810
  • Fax: 404-292-3848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR151734
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: