Individual
RICHARD WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
705 DIXIE ST, CARROLLTON, GA 30117-3818
(770) 836-9666
Mailing address
1581 STRIPLING CHAPEL RD, CARROLLTON, GA 30116-6908
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
056783
GA
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
056783
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
074623150A
—
GA
Enumeration date
04/27/2006
Last updated
04/28/2010
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