Provider Demographics
NPI:1295975985
Name:WHITLOCK, PAUL A (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:WHITLOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:460 MALL BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4801
Mailing Address - Country:US
Mailing Address - Phone:912-644-5300
Mailing Address - Fax:912-644-5260
Practice Address - Street 1:1000 N VETERANS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:GLENNVILLE
Practice Address - State:GA
Practice Address - Zip Code:30427-8603
Practice Address - Country:US
Practice Address - Phone:912-654-4599
Practice Address - Fax:912-644-5260
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2025-05-25
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Provider Licenses
StateLicense IDTaxonomies
GA012592207R00000X, 208600000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000053391FMedicaid
GA202I020853Medicare Oscar/Certification