Healthcare Provider Details

I. General information

NPI: 1992337034
Provider Name (Legal Business Name): WHITNEY SLOAN BANCROFT TRAMMELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WHITNEY SLOAN BANCROFT

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MANNSDALE PARK DR STE 1
MADISON MS
39110-6381
US

IV. Provider business mailing address

815 HIGHWAY 80 E
CLINTON MS
39056-5252
US

V. Phone/Fax

Practice location:
  • Phone: 601-910-3004
  • Fax: 601-910-3005
Mailing address:
  • Phone: 601-910-3004
  • Fax: 601-910-3005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00480
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: