Provider Demographics
NPI:1952842064
Name:WHATLEY, JILLIAN
Entity Type:Individual
Prefix:MISS
First Name:JILLIAN
Middle Name:
Last Name:WHATLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 TEMPLE PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052
Mailing Address - Country:US
Mailing Address - Phone:404-661-0867
Mailing Address - Fax:
Practice Address - Street 1:7130 MOUNT ZION CIR
Practice Address - Street 2:SUITE 7
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-3308
Practice Address - Country:US
Practice Address - Phone:404-661-0867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst