Individual
JODY L WHISENANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1276 JESSE JEWELL PKWY SE, GAINESVILLE, GA 30501-3823
(770) 532-7246
(770) 532-2683
Mailing address
1276 JESSE JEWELL PKWY SE, GAINESVILLE, GA 30501-3823
(770) 532-7246
(770) 532-2683
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1035T
GA
152WC0802X
Corneal and Contact Management Optometrist
1035T
GA
152WX0102X
Occupational Vision Optometrist
1035T
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00461667A
—
GA
01
—
1035T
GA STATE LICENSE
GA
01
—
2230019
UNITED HEALTHCARE
GA
05
—
300028600B
—
GA
01
—
537962
US HEALTHCARE
GA
01
—
CG8677
MEDICARE RAILROD GROUP
GA
Enumeration date
01/11/2007
Last updated
02/14/2008
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