Healthcare Provider Details

I. General information

NPI: 1093001620
Provider Name (Legal Business Name): ELIZABETH WHITTINGTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 S CONGRESS AVE
ATLANTIS FL
33462-1149
US

IV. Provider business mailing address

PO BOX 741087
ATLANTA GA
30384-1087
US

V. Phone/Fax

Practice location:
  • Phone: 561-548-3639
  • Fax: 561-548-3702
Mailing address:
  • Phone: 954-777-0018
  • Fax: 866-262-5507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME122482
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: