1811004088 NPI number — RYAN T WHITNEY MD

Table of content: RYAN T WHITNEY MD (NPI 1811004088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811004088 NPI number — RYAN T WHITNEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITNEY
Provider First Name:
RYAN
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811004088
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 742616
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-2616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-219-8420
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1404 RIVER PL STE 501
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRASELTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30517-5600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-534-2020
Provider Business Practice Location Address Fax Number:
770-534-8025
Provider Enumeration Date:
08/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X , with the licence number:  81697 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 081697 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 47084496100 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200283580B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0569244 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200283580A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 209012418 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7707950 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 209012400 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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