Provider Demographics
NPI:1013229889
Name:WHATLEY, SUSAN P (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:P
Last Name:WHATLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 CAMDEN HILL RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-7418
Mailing Address - Country:US
Mailing Address - Phone:770-339-4225
Mailing Address - Fax:
Practice Address - Street 1:170 CAMDEN HILL RD
Practice Address - Street 2:SUITE F
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7418
Practice Address - Country:US
Practice Address - Phone:770-339-4225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN183030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily