Individual
DR. JOHN CALVIN WHITLEY III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2828 HILLCREEK DR, AUGUSTA, GA 30909-5628
(706) 228-5006
(706) 228-1848
Mailing address
2828 HILLCREEK DR, AUGUSTA, GA 30909-5628
(706) 228-5006
(706) 228-1848
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1922
GA
103TC0700X
Clinical Psychologist
625
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PSO207
MEDICAID
SC
Enumeration date
11/21/2005
Last updated
07/08/2007
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