Individual provider Active NPI

Gabrielle Valliere-White, FNP-C

  • Family Nurse Practitioner
  • Fayetteville, GA
National Provider Identifier
1720769813
Registry record updated Feb 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN241046 Issued in GA
Practice address
1233 Sr-54 W
Suite 120
Fayetteville, GA 30214
Phone
(678) 272-1717
NPI assigned
Jul 31, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X RN241046 GA
Family Nurse Practitioner 363LF0000X RN241046 GA Primary

Addresses

Primary practice location

1233 Sr-54 W
Suite 120
Fayetteville, GA 30214

Mailing address

215 Somerset CT
McDonough, GA 30253-4015

Other practice location 1

1325 Rock Quarry Rd Ste 200
Stockbridge, GA 30281-5033
Phone (770) 389-0734

Other names 1

  • Gabrielle Valliere Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
RN241046GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Eagle'S Landing Longevity Center Internal Medicine CurrentSince Aug 1, 2023 Accepting new patients
Columbus Ambulatory Healthcare Services, Inc. PastSince Aug 1, 2023 Accepting new patients

Locations

1325 Rock Quarry Rd
Ste 200
Stockbridge, GA 30281
Phone (770) 389-0734

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1690761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738886400000",
    "number": "1720769813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 SOMERSET CT",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302534015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1233 SR-54 W",
            "address_2": "SUITE 120",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "30214",
            "telephone_number": "678-272-1717"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1325 Rock Quarry Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Stockbridge",
            "state": "GA",
            "postal_code": "302815033",
            "country_code": "US",
            "telephone_number": "770-389-0734",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VALLIERE-WHITE",
        "first_name": "GABRIELLE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-31",
        "last_updated": "2025-02-07",
        "certification_date": "2025-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "RN241046",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN241046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GABRIELLE",
            "last_name": "VALLIERE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fayetteville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.