Provider Demographics
NPI:1376997205
Name:WHIDDON, ROBERT A (PA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:WHIDDON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MOHAWK ST
Mailing Address - Street 2:STE E
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1844
Mailing Address - Country:US
Mailing Address - Phone:912-925-0067
Mailing Address - Fax:912-925-2381
Practice Address - Street 1:2045 PEACHTREE RD NE STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1497
Practice Address - Country:US
Practice Address - Phone:404-351-7546
Practice Address - Fax:404-351-2993
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007955363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant