Provider Demographics
NPI:1528053618
Name:WHITLOW, DONNA G (OD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:G
Last Name:WHITLOW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:407 S GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-3123
Mailing Address - Country:US
Mailing Address - Phone:706-882-0616
Mailing Address - Fax:706-882-8515
Practice Address - Street 1:407 S GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-3123
Practice Address - Country:US
Practice Address - Phone:706-882-0616
Practice Address - Fax:706-882-8515
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA41ZCDXKMedicare ID - Type Unspecified
GAU27746Medicare UPIN