Provider Demographics
NPI:1093878787
Name:WHITEHURST, JAMES H (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:H
Last Name:WHITEHURST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5428 FRIPP LN NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-8049
Mailing Address - Country:US
Mailing Address - Phone:262-309-1670
Mailing Address - Fax:
Practice Address - Street 1:1100 W PEACHTREE ST NW STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3609
Practice Address - Country:US
Practice Address - Phone:404-575-2050
Practice Address - Fax:404-575-2051
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51100-202085R0001X
GA727242085R0001X
TNMD 203752085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64797558Medicaid
TN3051403Medicaid
TN3051403Medicaid
KY64797558Medicaid