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General NPI Number Information
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NPI Number | 1245965813
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Entity Type | Organization
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Legal Business Name | BOARD OF REGENTS OF THE UNIVERSITY SYSTEM OF GEORGIA AND ON BEHALF....
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Dates
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Enumeration Date | 07/19/2022
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Last Update Date | 07/19/2022
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Provider Practice Location Address
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Address Line | 141 PIEDMONT AVE NE STE D
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City | ATLANTA
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State | GA
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Zip | 30303-2417
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Country | US
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Telephone | 404-413-1930
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Fax | 404-413-1955
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Provider Business Mailing Address
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Address Line | PO BOX 3996
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City | ATLANTA
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State | GA
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Zip | 30302-3996
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Country | US
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Telephone | 404-413-1930
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Fax | 404-413-1955
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. SUSAN MARIE WHITMER
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Credential | MD
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Telephone | 404-413-1930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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