Provider Demographics
NPI:1639373426
Name:WHITMER, SUSAN MARIE (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:WHITMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4074 CHIPPEWA PL NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-1522
Mailing Address - Country:US
Mailing Address - Phone:678-777-6737
Mailing Address - Fax:
Practice Address - Street 1:141 PIEDMONT AVE NE STE D
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-2417
Practice Address - Country:US
Practice Address - Phone:404-413-1930
Practice Address - Fax:404-413-1953
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24786208D00000X
TN58466208D00000X
GA87164208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice