Healthcare Provider Details

I. General information

NPI: 1639930613
Provider Name (Legal Business Name): WHITNEY RAE NORTON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 BROAD ST
HAWKINSVILLE GA
31036-4818
US

IV. Provider business mailing address

259 BROAD ST
HAWKINSVILLE GA
31036-4818
US

V. Phone/Fax

Practice location:
  • Phone: 478-300-7107
  • Fax: 478-205-0909
Mailing address:
  • Phone: 478-300-7107
  • Fax: 478-205-0909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberGAA-NP003231
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: