Provider Demographics
NPI:1780098046
Name:PETTY, ALISON NICOLE (WHNP-BC)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:NICOLE
Last Name:PETTY
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:NICOLE
Other - Last Name:ETHERIDGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 12938
Mailing Address - Street 2:C/O CLINIC MANAGEMENT
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703
Mailing Address - Country:US
Mailing Address - Phone:706-602-7800
Mailing Address - Fax:
Practice Address - Street 1:400 TIMMS RD NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-7016
Practice Address - Country:US
Practice Address - Phone:706-625-0022
Practice Address - Fax:706-625-8586
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN186285363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner