Healthcare Provider Details

I. General information

NPI: 1174489603
Provider Name (Legal Business Name): FRIDEA WHITBY MSN, APRN, PMHNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 RIDGE AVE
MACON GA
31204-2312
US

IV. Provider business mailing address

786 IVY BROOK WAY
MACON GA
31210-5528
US

V. Phone/Fax

Practice location:
  • Phone: 478-745-9206
  • Fax: 250-999-6620
Mailing address:
  • Phone: 478-952-9984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN283976
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: