Provider Demographics
NPI:1710653498
Name:WHITEHURST, VEYLON LEE (MED)
Entity Type:Individual
Prefix:MR
First Name:VEYLON
Middle Name:LEE
Last Name:WHITEHURST
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 PHARR COURT SOUTH NW APT 1113
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-4929
Mailing Address - Country:US
Mailing Address - Phone:202-509-7718
Mailing Address - Fax:
Practice Address - Street 1:2900 PHARR COURT SOUTH NW APT 1113
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-4929
Practice Address - Country:US
Practice Address - Phone:202-509-7718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-21
Last Update Date:2021-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty