Provider Demographics
NPI:1326175035
Name:WHITNEY, ELAINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 BUFORD HWY
Mailing Address - Street 2:BLDG N
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-8721
Mailing Address - Country:US
Mailing Address - Phone:770-945-2015
Mailing Address - Fax:770-932-8397
Practice Address - Street 1:1400 BUFORD HWY
Practice Address - Street 2:BLDG N
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-8721
Practice Address - Country:US
Practice Address - Phone:770-945-2015
Practice Address - Fax:770-932-8397
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA107501223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA734823OtherUNITED CONCORDIA