Provider Demographics
NPI:1295135697
Name:WHITEHEAD, ERICA LEIGH (PA-C)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:LEIGH
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 N WESTOVER BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-2983
Mailing Address - Country:US
Mailing Address - Phone:298-886-5592
Mailing Address - Fax:229-436-4107
Practice Address - Street 1:327 SUNSET AVE SW # 3
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:GA
Practice Address - Zip Code:39870
Practice Address - Country:US
Practice Address - Phone:229-734-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical