Provider Demographics
NPI:1881293660
Name:FUQUA, WHITNEY GAIL (DC)
Entity type:Individual
Prefix:DR
First Name:WHITNEY
Middle Name:GAIL
Last Name:FUQUA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3978 CYRUS CREST CIR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-2510
Mailing Address - Country:US
Mailing Address - Phone:757-408-3167
Mailing Address - Fax:
Practice Address - Street 1:1415 BARCLAY CIR SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-2943
Practice Address - Country:US
Practice Address - Phone:770-426-2786
Practice Address - Fax:770-792-6113
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009020111N00000X, 111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
No111N00000XChiropractic ProvidersChiropractor