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NPI Code Detail

MEDICARE: DR. AMANDA JOY WHITLEY MD

MEDICARE: DR. AMANDA JOY WHITLEY MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician200900819NC
2207Q00000XFamily Medicine Physician134118NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104955632
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMANDA JOY WHITLEY MD
Provider Business Mailing Address
First Line : PO BOX 60447
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0447
Country : US
Telephone Number : 704-384-1260
Fax Number : 704-384-1289
Provider Business Practice Location Address
First Line : 13460 PLAZA ROAD EXT STE 100
Second Line :
City : CHARLOTTE
State : NC
Zip : 28215-8923
Country : US
Telephone Number : 704-316-4990
Fax Number : 704-316-4998
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2007
Last Update Date : 05/20/2024

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Directions to “ DR. AMANDA JOY WHITLEY MD” Practice Location

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