Provider Demographics
NPI:1417089095
Name:WHITLOCK, KARL ALAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:ALAN
Last Name:WHITLOCK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1464 FENWICK DR SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-2779
Mailing Address - Country:US
Mailing Address - Phone:770-403-6352
Mailing Address - Fax:770-222-1909
Practice Address - Street 1:3849 OAKVIEW DR
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-2233
Practice Address - Country:US
Practice Address - Phone:770-403-6352
Practice Address - Fax:770-222-1909
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002229103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical