Provider Demographics
NPI:1962544684
Name:WHITEHEAD, JOANNE MARION (RN, MSN, FN-P)
Entity type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:MARION
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:RN, MSN, FN-P
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Mailing Address - Street 1:PO BOX 1587
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30722-1587
Mailing Address - Country:US
Mailing Address - Phone:706-529-7440
Mailing Address - Fax:706-529-7437
Practice Address - Street 1:1436 BROADRICK DR
Practice Address - Street 2:SUITE B
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3009
Practice Address - Country:US
Practice Address - Phone:706-226-3434
Practice Address - Fax:706-226-4820
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2024-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAR058514363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000770657DMedicaid
GA000770657DMedicaid
GA202I501883Medicare PIN
GAS44992Medicare UPIN