Healthcare Provider Details

I. General information

NPI: 1902963937
Provider Name (Legal Business Name): WHITEVILLE MEDICAL ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 JEFFERSON ST
WHITEVILLE NC
28472
US

IV. Provider business mailing address

823 JEFFERSON ST PO BOX 1528
WHITEVILLE NC
28472
US

V. Phone/Fax

Practice location:
  • Phone: 910-642-6121
  • Fax: 910-642-8457
Mailing address:
  • Phone: 910-642-6121
  • Fax: 910-642-8457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20979
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number24304
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number39134
License Number StateNC

VIII. Authorized Official

Name: DR. HENRY W TRAYLOR
Title or Position: PRESIDENT
Credential: MD
Phone: 910-642-6121