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General NPI Number Information
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NPI Number | 1417089095
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Entity Type | Individual
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Provider Name | KARL ALAN WHITLOCK PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 03/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3849 OAKVIEW DR
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-2233
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Country | US
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Telephone | 770-403-6352
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Fax | 770-222-1909
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Provider Business Mailing Address
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Address Line | 1464 FENWICK DR SW
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City | MARIETTA
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State | GA
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Zip | 30064-2779
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Country | US
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Telephone | 770-403-6352
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Fax | 770-222-1909
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 002229
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License Number State | GA
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