Provider Demographics
NPI:1891773792
Name:WILES, JANICE JEAN (APRN,BC, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:JEAN
Last Name:WILES
Suffix:
Gender:F
Credentials:APRN,BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 PINE BROOK WAY
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1225
Mailing Address - Country:US
Mailing Address - Phone:404-338-0688
Mailing Address - Fax:404-338-0688
Practice Address - Street 1:11685 ALPHARETTA HWY
Practice Address - Street 2:SUITE 155
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4913
Practice Address - Country:US
Practice Address - Phone:770-442-0836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN121491 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBLTSMedicare UPIN
GAP11150Medicare UPIN