Provider Demographics
NPI:1902248883
Name:MCCONNELL, WHITNEY ELLIS
Entity type:Individual
Prefix:DR
First Name:WHITNEY
Middle Name:ELLIS
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:WHITNEY
Other - Middle Name:ELIZABETH
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:4750 WATERS AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6261
Mailing Address - Country:US
Mailing Address - Phone:912-629-7800
Mailing Address - Fax:912-355-1414
Practice Address - Street 1:3226 HAMPTON AVE STE F
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4252
Practice Address - Country:US
Practice Address - Phone:912-629-7800
Practice Address - Fax:912-355-1414
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001330213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003190403BMedicaid
GA003190403CMedicaid
GA003190403DMedicaid