Healthcare Provider Details

I. General information

NPI: 1780547992
Provider Name (Legal Business Name): JOELY WHITING
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 PEACHTREE INDUSTRIAL BLVD STE 4203
SUWANEE GA
30024-4540
US

IV. Provider business mailing address

1300 PEACHTREE INDUSTRIAL BLVD STE 4203
SUWANEE GA
30024-4540
US

V. Phone/Fax

Practice location:
  • Phone: 770-831-3018
  • Fax:
Mailing address:
  • Phone: 770-831-3018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN333278
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: