Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | CHIR009020 | GA |
Y | 111NR0200X | Radiology | CHIR009020 | GA |
Y | 213ER0200X | Radiology | CHIR009020 | GA |
NPI | 1881293660 |
---|---|
Provider Name | Dr. Whitney Gail Fuqua |
First Address | Kennesaw, GA 30152-2510 |
Second Address | Marietta, GA 30060-2943 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2020 |
Last Update Date | 30/07/2021 |