Provider Demographics
NPI:1881639466
Name:WHITEHEAD, DOUGLAS WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:WAYNE
Last Name:WHITEHEAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W SAINT JOHN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-5179
Mailing Address - Country:US
Mailing Address - Phone:864-342-7070
Mailing Address - Fax:833-638-0121
Practice Address - Street 1:101 W SAINT JOHN ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-5179
Practice Address - Country:US
Practice Address - Phone:864-342-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15978207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5655029OtherAETNA ID
SC159786Medicaid
SC571004971012OtherBCBS OF SC ID
SC80109539OtherRR MEDICARE
SC1880582OtherCIGNA ID
SC571004971012OtherBCBS OF SC ID
SCF73361Medicare UPIN