Healthcare Provider Details

I. General information

NPI: 1295135697
Provider Name (Legal Business Name): ERICA LEIGH WHITEHEAD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 OSLER CT
ALBANY GA
31707-0205
US

IV. Provider business mailing address

2402 OSLER CT
ALBANY GA
31707-0205
US

V. Phone/Fax

Practice location:
  • Phone: 229-438-3300
  • Fax:
Mailing address:
  • Phone: 298-438-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7352
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number7352
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: