Healthcare Provider Details

I. General information

NPI: 1427576123
Provider Name (Legal Business Name): JEREMY WADE WHITMIRE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 09/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 S MAIN ST
ROBBINSVILLE NC
28771-8409
US

IV. Provider business mailing address

PO BOX 444
MURPHY NC
28906-0444
US

V. Phone/Fax

Practice location:
  • Phone: 828-479-6466
  • Fax: 828-479-9267
Mailing address:
  • Phone: 828-837-0071
  • Fax: 828-837-5309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC008677
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: