Provider Demographics
NPI:1346331618
Name:WHITLOCK, MARY ANNE (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANNE
Last Name:WHITLOCK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CHARLES CT
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-5722
Mailing Address - Country:US
Mailing Address - Phone:706-552-0653
Mailing Address - Fax:
Practice Address - Street 1:2 S MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7101
Practice Address - Country:US
Practice Address - Phone:706-769-0233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006784111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor