Healthcare Provider Details

I. General information

NPI: 1457963456
Provider Name (Legal Business Name): CATELYN CONWAY WHEELER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 02/24/2021
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 WHITCHER ST NE STE 250
MARIETTA GA
30060-1169
US

IV. Provider business mailing address

805 SANDY PLAINS ROAD MEDICAL STAFF SERVICES
MARIETTA GA
30066-6340
US

V. Phone/Fax

Practice location:
  • Phone: 478-957-9693
  • Fax:
Mailing address:
  • Phone: 770-792-5451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN253275
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: