Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | RN018253NP | GA |
NPI | 1023232188 |
---|---|
Provider Name | Joy Bernice Whaley |
First Address | Dalton, GA 30721-8015 |
Second Address | Dalton, GA 30720-2536 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0005201654 | (05) | GA |