Provider Demographics
NPI:1265897326
Name:LIPSEY, WHITNEY QUINLAN (NP)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:QUINLAN
Last Name:LIPSEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:
Other - Last Name:QUINLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1505 NORTHSIDE BLVD
Mailing Address - Street 2:STE 2800
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7623
Mailing Address - Country:US
Mailing Address - Phone:770-886-3842
Mailing Address - Fax:770-886-3843
Practice Address - Street 1:3890 JOHNS CREEK PKWY STE 360
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024
Practice Address - Country:US
Practice Address - Phone:678-735-5300
Practice Address - Fax:678-735-5305
Is Sole Proprietor?:No
Enumeration Date:2015-12-16
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN214040363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003171389CMedicaid
GA003171389AMedicaid
GA003171389AMedicaid