Provider Demographics
NPI:1700266418
Name:WHITLOW, MICHAEL BROUGHTEN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BROUGHTEN
Last Name:WHITLOW
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 1:1109 MEDICAL CENTER DR STE 5
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6639
Mailing Address - Country:US
Mailing Address - Phone:706-863-6637
Mailing Address - Fax:706-863-6638
Practice Address - Street 1:1109 MEDICAL CENTER DR STE 5
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6639
Practice Address - Country:US
Practice Address - Phone:706-863-6637
Practice Address - Fax:706-863-6638
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL38334207R00000X
GA85172207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine