Provider Demographics
NPI:1992912125
Name:WHITTAKER, EMMA J (CERTIFIED NURSING AS)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:J
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:CERTIFIED NURSING AS
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:J
Other - Last Name:PETERSON DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 93035
Mailing Address - Street 2:5092 LELAND DRIVE
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30377
Mailing Address - Country:US
Mailing Address - Phone:770-879-9472
Mailing Address - Fax:
Practice Address - Street 1:5092 LELAND DRIVE
Practice Address - Street 2:
Practice Address - City:STONE MTN
Practice Address - State:GA
Practice Address - Zip Code:30083
Practice Address - Country:US
Practice Address - Phone:770-879-9472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0028865067376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide