Provider Demographics
NPI:1912994690
Name:SUTHERLAND, JOANNA WILSON (NP)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:WILSON
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:JOANNA
Other - Middle Name:DENISE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:333 COMMERCE ST STE 700
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37201-1835
Mailing Address - Country:US
Mailing Address - Phone:615-454-9850
Mailing Address - Fax:
Practice Address - Street 1:1200 ABERNATHY RD STE 1700
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5671
Practice Address - Country:US
Practice Address - Phone:770-325-0636
Practice Address - Fax:855-737-5542
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN110992363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPENDINGMedicare ID - Type Unspecified
PENDINGMedicare UPIN
PENDINGMedicare UPIN