Provider Demographics
NPI:1932659174
Name:HANES, WHITNEY JEAN (PAC)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:JEAN
Last Name:HANES
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 HOSPITAL BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4947
Mailing Address - Country:US
Mailing Address - Phone:770-664-9600
Mailing Address - Fax:
Practice Address - Street 1:470 NORTHSIDE CHEROKEE BLVD STE 170
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8029
Practice Address - Country:US
Practice Address - Phone:770-721-9540
Practice Address - Fax:770-721-9541
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA8196363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program