Provider Demographics
NPI:1841624731
Name:WHITFIELD, BRYAN WATKINS VI (MD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:WATKINS
Last Name:WHITFIELD
Suffix:VI
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 1:980 SANDERS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-5977
Mailing Address - Country:US
Mailing Address - Phone:770-886-1074
Mailing Address - Fax:770-205-4717
Practice Address - Street 1:980 SANDERS RD STE 100
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-5977
Practice Address - Country:US
Practice Address - Phone:770-886-1074
Practice Address - Fax:770-205-4717
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL37087208600000X
390200000X
FL29636390200000X
GA87251208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL29636OtherFLORIDA BOARD OF MEDICINE
SCLL37087OtherSTATE OF SOUTH CAROLINA LIMITED LICENSE