Provider Demographics
NPI:1831682244
Name:WHEATON, JENELLE ELIZABETH
Entity type:Individual
Prefix:
First Name:JENELLE
Middle Name:ELIZABETH
Last Name:WHEATON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 HIGHLAND SQUARE DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-2295
Mailing Address - Country:US
Mailing Address - Phone:706-344-2786
Mailing Address - Fax:
Practice Address - Street 1:EMORY UNIVERSITY HOSPITAL MIDTOWN
Practice Address - Street 2:550 PEACHTREE ST NE,
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308
Practice Address - Country:US
Practice Address - Phone:404-778-7402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant