Provider Demographics
NPI:1750174470
Name:WHITCOMB, AMY D (LPN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:D
Last Name:WHITCOMB
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 OAK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-4159
Mailing Address - Country:US
Mailing Address - Phone:770-851-1146
Mailing Address - Fax:
Practice Address - Street 1:270 HERITAGE WALK
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3875
Practice Address - Country:US
Practice Address - Phone:678-494-5700
Practice Address - Fax:678-494-5703
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN102126164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse