Provider Demographics
NPI:1710114517
Name:WHITTIER, XENA ANTOINETTE (MD)
Entity Type:Individual
Prefix:
First Name:XENA
Middle Name:ANTOINETTE
Last Name:WHITTIER
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 1:700 CHURCH ST NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7220
Mailing Address - Country:US
Mailing Address - Phone:770-420-1690
Mailing Address - Fax:770-420-1661
Practice Address - Street 1:700 CHURCH ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7220
Practice Address - Country:US
Practice Address - Phone:770-420-1690
Practice Address - Fax:770-420-1661
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA074620207RR0500X
LAMD.205332208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00986895Medicaid
LA1958221Medicaid
LA4R0537061Medicare PIN