Provider Demographics
NPI:1982181152
Name:WHATLEY, DIANA (FNP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:WHATLEY
Suffix:
Gender:F
Credentials:FNP
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 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8430
Mailing Address - Fax:
Practice Address - Street 1:1496 WINDER HWY STE 100
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-5468
Practice Address - Country:US
Practice Address - Phone:770-848-5400
Practice Address - Fax:770-848-5424
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN208073363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1851449127OtherMEDICARE AND PRIVATE INSURANCE (OFFICE DOESN'T ACCEPT MEDICAID)