Provider Demographics
NPI:1811004088
Name:WHITNEY, RYAN T (MD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:T
Last Name:WHITNEY
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:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:
Practice Address - Street 1:1404 RIVER PL STE 501
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-5600
Practice Address - Country:US
Practice Address - Phone:770-534-2020
Practice Address - Fax:770-534-8025
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA81697207RI0011X
GA081697207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47084496100Medicaid
KS200283580BMedicaid
IA0569244Medicaid
KS200283580AMedicaid
MO209012418Medicaid
SD7707950Medicaid
MO209012400Medicaid
NE47084496100Medicaid
NEH65048Medicare UPIN
IAI9727Medicare PIN
NE060068754Medicare PIN
IA0569244Medicaid
MOM48C437Medicare PIN