Provider Demographics
NPI:1619011129
Name:WHITLEY, LLC
Entity Type:Organization
Organization Name:WHITLEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVITT
Authorized Official - Suffix:
Authorized Official - Credentials:CRNFA
Authorized Official - Phone:706-356-5600
Mailing Address - Street 1:709 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:GA
Mailing Address - Zip Code:30557-3573
Mailing Address - Country:US
Mailing Address - Phone:706-356-5600
Mailing Address - Fax:
Practice Address - Street 1:709 WILSON RD
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:GA
Practice Address - Zip Code:30557-3573
Practice Address - Country:US
Practice Address - Phone:706-356-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA147341163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Multi-Specialty