Provider Demographics
NPI:1508180373
Name:WHITESIDE, ADAM (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:WHITESIDE
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:PO BOX 1345
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31402-1345
Mailing Address - Country:US
Mailing Address - Phone:912-232-9700
Mailing Address - Fax:912-232-9701
Practice Address - Street 1:5356 REYNOLDS ST
Practice Address - Street 2:201
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6016
Practice Address - Country:US
Practice Address - Phone:912-232-9700
Practice Address - Fax:912-232-9701
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA070009207P00000X
390200000X
KY207P00000X146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant