Provider Demographics
NPI:1356870299
Name:WHITLEY, ALLIE GRACE (DO)
Entity type:Individual
Prefix:
First Name:ALLIE
Middle Name:GRACE
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3980 HIGHWAY 9 E STE 100
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-8163
Mailing Address - Country:US
Mailing Address - Phone:843-390-8320
Mailing Address - Fax:843-390-8329
Practice Address - Street 1:3980 HIGHWAY 9 E STE 100
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-8163
Practice Address - Country:US
Practice Address - Phone:843-390-8320
Practice Address - Fax:843-390-8329
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC225499207Q00000X
SC83049207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine