Basic Information
Provider Information
NPI: 1407443575
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DOCKERY
FirstName: WHITNEY
MiddleName: LEANNE
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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Mailing Information
Address1: PO BOX 658
Address2:  
City: GAINESVILLE
State: GA
PostalCode: 305030658
CountryCode: US
TelephoneNumber: 7707181122
FaxNumber: 7705334786
Practice Location
Address1: 725 JESSE JEWELL PKWY SE
Address2:  
City: GAINESVILLE
State: GA
PostalCode: 305013834
CountryCode: US
TelephoneNumber: 7702972200
FaxNumber: 7705348139
Other Information
ProviderEnumerationDate: 12/23/2020
LastUpdateDate: 12/23/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/23/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367A00000XRN149342GAY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

No ID Information.


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