Provider Demographics
NPI:1396967162
Name:THE UROLOGY GROUP WHITLOCK & DEVORE
Entity type:Organization
Organization Name:THE UROLOGY GROUP WHITLOCK & DEVORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NORRIS W WHITLOCK MD
Authorized Official - Prefix:MR
Authorized Official - First Name:NORRIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:WHITLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-879-7481
Mailing Address - Street 1:420 THE PARKWAY
Mailing Address - Street 2:BLDG C
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650
Mailing Address - Country:US
Mailing Address - Phone:864-879-7481
Mailing Address - Fax:864-879-1293
Practice Address - Street 1:420 THE PARKWAY
Practice Address - Street 2:BLDG C
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650
Practice Address - Country:US
Practice Address - Phone:864-879-7481
Practice Address - Fax:864-879-1293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9586208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2090Medicaid
5905Medicare PIN