Provider Demographics
NPI:1508099839
Name:BROOKS, WHITNEY HAMMER (PAC)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:HAMMER
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 S HAWTHORNE RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3921
Mailing Address - Country:US
Mailing Address - Phone:336-760-4340
Mailing Address - Fax:336-765-2869
Practice Address - Street 1:1901 S HAWTHORNE RD
Practice Address - Street 2:SUITE 310
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3921
Practice Address - Country:US
Practice Address - Phone:336-760-4340
Practice Address - Fax:336-765-2869
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01921363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2762031Medicare PIN