Provider Demographics
NPI:1881694388
Name:WHITWORTH, STEVEN R (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:WHITWORTH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4181 HOSPITAL DR NE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2541
Mailing Address - Country:US
Mailing Address - Phone:770-787-6957
Mailing Address - Fax:770-784-0381
Practice Address - Street 1:4181 HOSPITAL DR NE
Practice Address - Street 2:SUITE 303
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2541
Practice Address - Country:US
Practice Address - Phone:770-787-6957
Practice Address - Fax:770-784-0381
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2016-07-15
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Provider Licenses
StateLicense IDTaxonomies
GA20848208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000279441DMedicaid