Provider Demographics
NPI:1528328481
Name:VANCE, WHITNEY BROOKE (MD)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:BROOKE
Last Name:VANCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 MILULI AVE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-5700
Mailing Address - Country:US
Mailing Address - Phone:229-243-0152
Mailing Address - Fax:229-246-9945
Practice Address - Street 1:1501 MILULI AVE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-5700
Practice Address - Country:US
Practice Address - Phone:229-243-0152
Practice Address - Fax:229-246-9945
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005429207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003138484BMedicaid
GA076515OtherMEDICAL LICENSE