Provider Demographics
NPI:1013687342
Name:MINK, WHITNEY ANN
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:ANN
Last Name:MINK
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 1:3315 ROSWELL RD NE APT 2008
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1417
Mailing Address - Country:US
Mailing Address - Phone:513-917-7737
Mailing Address - Fax:
Practice Address - Street 1:3315 ROSWELL RD NE APT 2008
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1417
Practice Address - Country:US
Practice Address - Phone:513-917-7737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant