Provider Demographics
NPI:1336365063
Name:WHITTINGSLOW, EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:WHITTINGSLOW
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 1:3736 MIKE PADGETT HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-0719
Mailing Address - Country:US
Mailing Address - Phone:706-560-2273
Mailing Address - Fax:706-560-0903
Practice Address - Street 1:3736 MIKE PADGETT HWY
Practice Address - Street 2:SUITE A
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-0719
Practice Address - Country:US
Practice Address - Phone:706-560-2273
Practice Address - Fax:706-560-0903
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056941207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI49073Medicare UPIN
GA93BFDNGMedicare PIN