MEDICARE: DR. ELIZABETH G WHITAKER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	041239	GA
2	2082S0099X	Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician	041239	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811999402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH G WHITAKER M.D.

Provider Business Mailing Address
First Line	:	3200 COBB GALLERIA PKWY STE 205
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-5919
Country	:	US
Telephone Number	:	770-850-0202
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 COBB GALLERIA PKWY STE 205
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-5919
Country	:	US
Telephone Number	:	770-850-0202
Fax Number	:	770-850-0022

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	04/11/2012

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