Individual
JACQUELINE WIETING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-BC
Contact information
Practice address
1968 PEACHTREE RD NW BLDG 775TH, ATLANTA, GA 30309-1281
(404) 605-4600
Mailing address
2727 PACES FERRY RD SE STE 1-1100, ATLANTA, GA 30339-6151
(470) 271-3418
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
RN263743
GA
363LA2100X
Acute Care Nurse Practitioner
Primary
11003569
FL
Other
Enumeration date
02/01/2018
Last updated
05/13/2022
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