Healthcare Provider Details

I. General information

NPI: 1477011039
Provider Name (Legal Business Name): RHOCHELLE WILHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2019
Last Update Date: 03/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5475 MEMORIAL DR
STONE MOUNTAIN GA
30083-3247
US

IV. Provider business mailing address

1969 CORNERS CIR
LITHONIA GA
30058-5391
US

V. Phone/Fax

Practice location:
  • Phone: 678-515-7523
  • Fax:
Mailing address:
  • Phone: 678-761-9835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberCOA012341
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: