Provider Demographics
NPI:1023232188
Name:WHALEY, JOY BERNICE (NP)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:BERNICE
Last Name:WHALEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 BEAVERDALE RD NE
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-8015
Mailing Address - Country:US
Mailing Address - Phone:706-259-5508
Mailing Address - Fax:706-281-2325
Practice Address - Street 1:808 PROFESSIONAL BLVD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2536
Practice Address - Country:US
Practice Address - Phone:706-226-2621
Practice Address - Fax:706-281-2325
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN018253NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0005201654Medicaid