Provider Demographics
NPI:1932273877
Name:WHITMORE, SIMONE (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMONE
Middle Name:
Last Name:WHITMORE
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 1:3460 SUMMIT RIDGE PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1622
Mailing Address - Country:US
Mailing Address - Phone:678-584-9223
Mailing Address - Fax:678-584-9221
Practice Address - Street 1:3460 SUMMIT RIDGE PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1622
Practice Address - Country:US
Practice Address - Phone:678-584-9223
Practice Address - Fax:678-584-9221
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048099207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000851199DMedicaid
GA16BDTGPMedicare ID - Type Unspecified
GA000851199DMedicaid
GAH08802Medicare UPIN