Healthcare Provider Details

I. General information

NPI: 1821039991
Provider Name (Legal Business Name): BROOKS A WHITNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BROOKS ALAN WHITNEY MD

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5671 PEACHTREE DUNWOODY RD STE 620
ATLANTA GA
30342-5006
US

IV. Provider business mailing address

MANGED CARE DEPARTMENT NORTHSIDE HOSPITAL 1000 JOHNSON FERRY RD NE
ATLANTA GA
30342
US

V. Phone/Fax

Practice location:
  • Phone: 678-369-5454
  • Fax: 678-369-5455
Mailing address:
  • Phone: 404-300-2476
  • Fax: 404-250-8010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number036903
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: