Individual
MR. ROBERT G WHITENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2878 FIVE FORKS TRICKUM RD, SUITE 2A, LAWRENCEVILLE, GA 30044-5896
(678) 344-8700
(678) 344-8600
Mailing address
204 CHELSEA CT, WOODSTOCK, GA 30189-8173
(678) 344-8700
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
002074
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002074
LICENSE
GA
Enumeration date
09/15/2006
Last updated
11/02/2012
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