1992912125 NPI number — EMMA J WHITTAKER CERTIFIED NURSING AS

Table of content: EMMA J WHITTAKER CERTIFIED NURSING AS (NPI 1992912125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992912125 NPI number — EMMA J WHITTAKER CERTIFIED NURSING AS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITTAKER
Provider First Name:
EMMA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CERTIFIED NURSING AS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PETERSON DAVIS
Provider Other First Name:
EMMA
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992912125
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 93035
Provider Second Line Business Mailing Address:
5092 LELAND DRIVE
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30377
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-879-9472
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5092 LELAND DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STONE MTN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-879-9472
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 376K00000X , with the licence number:  CN0028865067 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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