Individual
EBONY B WHISENANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
AUGUSTA UNIVERSITY MEDICAL CTR 1120 15TH STREET, AUGUSTA, GA 30912-2516
(706) 721-8623
(706) 721-1459
Mailing address
1120 15TH ST STE BI1056, AUGUSTA, GA 30912-0004
(706) 721-3813
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
83947
GA
207Q00000X
Family Medicine Physician
ME106882
FL
207Q00000X
Family Medicine Physician
TRN12292
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
83947
GEORGIA MEDICAL LICENSE
GA
Enumeration date
06/26/2008
Last updated
11/01/2019
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