Provider Demographics
NPI:1811641442
Name:WHITEMAN, ALISA-ANN ADEL (MA)
Entity type:Individual
Prefix:MRS
First Name:ALISA-ANN
Middle Name:ADEL
Last Name:WHITEMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:938 ELMA G MILES PKWY
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-4515
Mailing Address - Country:US
Mailing Address - Phone:912-492-6331
Mailing Address - Fax:
Practice Address - Street 1:938 ELMA G MILES PKWY
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4515
Practice Address - Country:US
Practice Address - Phone:912-492-6331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA27833251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services