Provider Demographics
NPI:1740264134
Name:WHIPPLE, ROBERT L IV (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:WHIPPLE
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:775 POPLAR RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-8300
Mailing Address - Country:US
Mailing Address - Phone:770-400-8450
Mailing Address - Fax:770-400-8451
Practice Address - Street 1:775 POPLAR RD
Practice Address - Street 2:SUITE 150
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-8300
Practice Address - Country:US
Practice Address - Phone:770-400-8450
Practice Address - Fax:770-400-8451
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2014-09-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA046279208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000020523QMedicaid