Healthcare Provider Details

I. General information

NPI: 1760979256
Provider Name (Legal Business Name): WOOD WHITTINGTON DALE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 E FORTIFICATION ST
JACKSON MS
39202-2442
US

IV. Provider business mailing address

2500 N STATE ST
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-354-4488
  • Fax: 601-351-5980
Mailing address:
  • Phone: 601-984-6526
  • Fax: 601-984-5151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number31018
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: