Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 19241 | SC |
NPI | 1003205626 |
---|---|
Provider Name | David H Whiteside |
First Address | Atlanta, GA 30374-3070 |
Second Address | Spartanburg, SC 29303-4201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2015 |
Last Update Date | 14/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
19241 | SC LICENSE (01) | SC |
SC56206067 | MEDICARE PIN (01) | SC |
SC56206121 | MEDICARE PIN (01) | SC |
SC5620J577 | MEDICARE PIN (01) | SC |