Provider Demographics
NPI:1053870907
Name:WHITTAKER, DANIELLE E (MD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:E
Last Name:WHITTAKER
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 1:3915 CASCADE RD SW STE T-115
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8533
Mailing Address - Country:US
Mailing Address - Phone:404-564-7749
Mailing Address - Fax:404-699-6798
Practice Address - Street 1:3915 CASCADE RD SW STE T-115
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8533
Practice Address - Country:US
Practice Address - Phone:404-564-7749
Practice Address - Fax:404-699-6798
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA96559208000000X
TXT6077208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics