Provider Demographics
NPI:1720328362
Name:WEATHERSPOON, CARLETTA PETRONELLA (NP)
Entity type:Individual
Prefix:
First Name:CARLETTA
Middle Name:PETRONELLA
Last Name:WEATHERSPOON
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:160 RESERVE DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-5898
Mailing Address - Country:US
Mailing Address - Phone:516-317-7337
Mailing Address - Fax:
Practice Address - Street 1:2292 PEACHTREE RD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1147
Practice Address - Country:US
Practice Address - Phone:404-996-0120
Practice Address - Fax:404-351-6762
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2025-05-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF337753-1363LF0000X
GARN267270363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily