Healthcare Provider Details

I. General information

NPI: 1730448564
Provider Name (Legal Business Name): MARILYN ELAINE SIMS WHITENING APRN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARILYN ELAINE WHITENING APRN

II. Dates (important events)

Enumeration Date: 05/14/2012
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 N CHEROKEE RD STE A
SOCIAL CIRCLE GA
30025-4019
US

IV. Provider business mailing address

761 N CHEROKEE RD STE A
SOCIAL CIRCLE GA
30025-4019
US

V. Phone/Fax

Practice location:
  • Phone: 770-464-5022
  • Fax: 470-441-7375
Mailing address:
  • Phone: 770-464-5022
  • Fax: 470-441-7375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN178489
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN178489
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: