Provider Demographics
NPI:1194867713
Name:FOSE, WHITNEY LAUREN (MD)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:LAUREN
Last Name:FOSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:LAUREN
Other - Last Name:MCCALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1768 GRAND OAKS DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4805
Mailing Address - Country:US
Mailing Address - Phone:630-276-9212
Mailing Address - Fax:
Practice Address - Street 1:1007 WEATHERSTONE PKWY STE 210
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4497
Practice Address - Country:US
Practice Address - Phone:470-203-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA92861208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036120817Medicaid