Provider Demographics
NPI:1386686384
Name:WHIPPLE, OLIVER C (MD)
Entity Type:Individual
Prefix:
First Name:OLIVER
Middle Name:C
Last Name:WHIPPLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 WATERS AVE 1ST FLOOR MUS BLDG
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404
Mailing Address - Country:US
Mailing Address - Phone:912-350-3438
Mailing Address - Fax:912-350-9037
Practice Address - Street 1:4700 WATERS AVE
Practice Address - Street 2:1ST FL., MUS BLDG.
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404
Practice Address - Country:US
Practice Address - Phone:912-350-3438
Practice Address - Fax:912-350-9037
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052035208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10065477OtherAMERIGROUP
GAP00253189OtherRAILROAD MEDICARE
GA52177728-001OtherBCBS GA
GA363712785DMedicaid
GA363712785FMedicaid
GA349838OtherWELLCARE
GA363712785GMedicaid
GA52177728-003OtherBCBS GA
SCG52035Medicaid
GAP00253189OtherRAILROAD MEDICARE
GA349838OtherWELLCARE
GA10065477OtherAMERIGROUP
GA363712785EMedicaid
GA363712785DMedicaid
GA363712785GMedicaid