Provider Demographics
NPI:1669516795
Name:WHITEHEAD, EDDIE L (MD)
Entity type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:L
Last Name:WHITEHEAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1350 MONTREAL RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-8146
Mailing Address - Country:US
Mailing Address - Phone:770-593-2382
Mailing Address - Fax:770-598-1858
Practice Address - Street 1:1350 MONTREAL RD
Practice Address - Street 2:SUITE 290
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-8146
Practice Address - Country:US
Practice Address - Phone:770-593-2382
Practice Address - Fax:770-598-1858
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2012-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA032087207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine