Healthcare Provider Details

I. General information

NPI: 1891773792
Provider Name (Legal Business Name): JANICE JEAN WILES APRN,BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 01/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11685 ALPHARETTA HWY SUITE 155
ROSWELL GA
30076-4913
US

IV. Provider business mailing address

260 PINE BROOK WAY
ROSWELL GA
30076-1225
US

V. Phone/Fax

Practice location:
  • Phone: 770-442-0836
  • Fax:
Mailing address:
  • Phone: 404-338-0688
  • Fax: 404-338-0688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN121491 NP
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: