Provider Demographics
NPI:1023533734
Name:WHIBBEY, TERRELL WHIBBEY (CNA)
Entity type:Individual
Prefix:
First Name:TERRELL
Middle Name:WHIBBEY
Last Name:WHIBBEY
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 AVERA LN
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-5200
Mailing Address - Country:US
Mailing Address - Phone:478-294-0854
Mailing Address - Fax:
Practice Address - Street 1:88 AVERA LN
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31009
Practice Address - Country:US
Practice Address - Phone:478-294-0854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0014193642376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide