Provider Demographics
NPI:1063241180
Name:WILHITE, KELLY JONES (CTNC)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:JONES
Last Name:WILHITE
Suffix:
Gender:F
Credentials:CTNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1639 TAILMORE LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-7862
Mailing Address - Country:US
Mailing Address - Phone:404-915-8724
Mailing Address - Fax:
Practice Address - Street 1:1639 TAILMORE LN
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-7862
Practice Address - Country:US
Practice Address - Phone:404-915-8724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty