Provider Demographics
NPI:1376004853
Name:WHITLOW, AMY ZIMMERMAN (DO)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:ZIMMERMAN
Last Name:WHITLOW
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:ALISE
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1175 CORPORATE PARK DR
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-2238
Mailing Address - Country:US
Mailing Address - Phone:434-525-6964
Mailing Address - Fax:434-525-4035
Practice Address - Street 1:1175 CORPORATE PARK DR
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-2238
Practice Address - Country:US
Practice Address - Phone:434-525-6964
Practice Address - Fax:434-525-4035
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0102207326207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program