Provider Demographics
NPI:1356925127
Name:EQUITY ADVANCED NURSING AND WELLNESS SERVICES LLC
Entity type:Organization
Organization Name:EQUITY ADVANCED NURSING AND WELLNESS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/APRN
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITENING
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:678-773-2314
Mailing Address - Street 1:761 N CHEROKEE ROAD
Mailing Address - Street 2:STE A
Mailing Address - City:SOCIAL CIRCLE
Mailing Address - State:GA
Mailing Address - Zip Code:30025
Mailing Address - Country:US
Mailing Address - Phone:678-773-2314
Mailing Address - Fax:470-441-7375
Practice Address - Street 1:761 N CHEROKEE ROAD
Practice Address - Street 2:STE A
Practice Address - City:SOCIAL CIRCLE
Practice Address - State:GA
Practice Address - Zip Code:30025
Practice Address - Country:US
Practice Address - Phone:678-773-2314
Practice Address - Fax:470-441-7375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-07
Last Update Date:2023-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty