Provider Demographics
NPI:1962763771
Name:WHITLEY, LAUREN (MD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:28 MARKET ST STE 128
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-1512
Mailing Address - Country:US
Mailing Address - Phone:912-357-2022
Mailing Address - Fax:912-296-0561
Practice Address - Street 1:765 FLORENCE RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-3451
Practice Address - Country:US
Practice Address - Phone:731-925-2300
Practice Address - Fax:731-925-3506
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC34920207Q00000X
TN53698207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ018241Medicaid