Provider Demographics
NPI:1679659460
Name:WHITLOCK, ELEANOR LEIGH (MED)
Entity Type:Individual
Prefix:MRS
First Name:ELEANOR
Middle Name:LEIGH
Last Name:WHITLOCK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 BOWERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CARNESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30521-6908
Mailing Address - Country:US
Mailing Address - Phone:706-384-4344
Mailing Address - Fax:
Practice Address - Street 1:735 BOWERSVILLE RD
Practice Address - Street 2:
Practice Address - City:CARNESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30521-6908
Practice Address - Country:US
Practice Address - Phone:706-384-4344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator