Healthcare Provider Details

I. General information

NPI: 1205818242
Provider Name (Legal Business Name): WILLIAM DAVID WHITLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 GENE REED RD
BIRMINGHAM AL
35235-2405
US

IV. Provider business mailing address

4200 COLONNADE PKWY
BIRMINGHAM AL
35243-2342
US

V. Phone/Fax

Practice location:
  • Phone: 205-836-2942
  • Fax: 205-836-2946
Mailing address:
  • Phone: 205-971-7613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number00021035
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: