Provider Demographics
NPI:1891318333
Name:WHATLEY, MICHELLE CATHLEEN (RN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CATHLEEN
Last Name:WHATLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 375
Mailing Address - Street 2:
Mailing Address - City:CANON
Mailing Address - State:GA
Mailing Address - Zip Code:30520-0375
Mailing Address - Country:US
Mailing Address - Phone:207-206-6880
Mailing Address - Fax:
Practice Address - Street 1:250 BRAY STREET
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601
Practice Address - Country:US
Practice Address - Phone:706-612-6995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN184307363LF0000X
GA184307163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse