Healthcare Provider Details

I. General information

NPI: 1962403766
Provider Name (Legal Business Name): DAVID C WHITEHEAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 MEMORIAL DRIVE
JESUP GA
31545
US

IV. Provider business mailing address

PO BOX 71291
PHILADELPHIA PA
19176-1291
US

V. Phone/Fax

Practice location:
  • Phone: 912-559-2337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number050852
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: