Provider Demographics
NPI:1821039991
Name:WHITNEY, BROOKS A (MD)
Entity Type:Individual
Prefix:
First Name:BROOKS
Middle Name:A
Last Name:WHITNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BROOKS
Other - Middle Name:ALAN
Other - Last Name:WHITNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:MANGED CARE DEPARTMENT NORTHSIDE HOSPITAL
Mailing Address - Street 2:1000 JOHNSON FERRY RD NE
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-300-2476
Mailing Address - Fax:404-250-8010
Practice Address - Street 1:5671 PEACHTREE DUNWOODY RD STE 620
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-5006
Practice Address - Country:US
Practice Address - Phone:678-369-5454
Practice Address - Fax:678-369-5455
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0369032086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003118708BMedicaid
GA003118708AMedicaid
GA003118708FMedicaid
GA003118708EMedicaid
GA003118708JMedicaid
GA003118708CMedicaid
GA003118708HMedicaid
GA003118708GMedicaid
GA003118708IMedicaid
GA00543628AMedicaid
GA770000209OtherRR MCE
GA003118708DMedicaid
GA003118708CMedicaid
GA003118708DMedicaid
GA76BBBBBMedicare PIN