=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811474828
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER WHITNEY ELDRIDGE FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2018
-----------------------------------------------------
Last Update Date | 08/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 GEORGIA AVE
-----------------------------------------------------
City | VALDOSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31602-3843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-333-5886
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4872 BROWN CAT CIR
-----------------------------------------------------
City | HAHIRA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31632-2673
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-499-9784
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN229032
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------