Healthcare Provider Details

I. General information

NPI: 1023484888
Provider Name (Legal Business Name): RONALD WHITTINGTON D.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 TOWNE CENTER BLVD., STE 203
RIDGELAND MS
39157-4837
US

IV. Provider business mailing address

PO BOX 2412
MADISON MS
39130-2412
US

V. Phone/Fax

Practice location:
  • Phone: 601-707-7197
  • Fax: 601-707-7292
Mailing address:
  • Phone: 601-707-7197
  • Fax: 601-707-7292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2013
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: