Provider Demographics
NPI:1053303404
Name:WHITCOMB, DAVID SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SCOTT
Last Name:WHITCOMB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1521 JOHNSON FERRY RD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6404
Mailing Address - Country:US
Mailing Address - Phone:770-579-0777
Mailing Address - Fax:770-579-3777
Practice Address - Street 1:1521 JOHNSON FERRY RD
Practice Address - Street 2:SUITE 135
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6404
Practice Address - Country:US
Practice Address - Phone:770-579-0777
Practice Address - Fax:770-579-3777
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-20
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA187672084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000132404HMedicaid
GA000132404HMedicaid
GA13BDCHWMedicare ID - Type Unspecified