Healthcare Provider Details

I. General information

NPI: 1356925127
Provider Name (Legal Business Name): EQUITY ADVANCED NURSING AND WELLNESS SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 04/01/2023
Certification Date: 04/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 N CHEROKEE ROAD STE A
SOCIAL CIRCLE GA
30025
US

IV. Provider business mailing address

761 N CHEROKEE ROAD STE A
SOCIAL CIRCLE GA
30025
US

V. Phone/Fax

Practice location:
  • Phone: 678-773-2314
  • Fax: 470-441-7375
Mailing address:
  • Phone: 678-773-2314
  • Fax: 470-441-7375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARILYN WHITENING
Title or Position: CEO/APRN
Credential: APRN
Phone: 678-773-2314