Provider Demographics
NPI:1811999402
Name:WHITAKER, ELIZABETH G (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:G
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 COBB GALLERIA PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5919
Mailing Address - Country:US
Mailing Address - Phone:770-850-0202
Mailing Address - Fax:
Practice Address - Street 1:3200 COBB GALLERIA PKWY STE 205
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5919
Practice Address - Country:US
Practice Address - Phone:770-850-0202
Practice Address - Fax:770-850-0022
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041239207Y00000X, 2082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00868524BMedicaid
GA04BDCKWMedicare ID - Type Unspecified
GA00868524BMedicaid