Healthcare Provider Details

I. General information

NPI: 1386629632
Provider Name (Legal Business Name): JOHN C WHITTINGTON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 08/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 MOUNT SAINT MARYS DR
NELSONVILLE OH
45764-1280
US

IV. Provider business mailing address

PO BOX 188
CHILLICOTHEE OH
45601-0188
US

V. Phone/Fax

Practice location:
  • Phone: 740-797-2352
  • Fax: 740-775-9159
Mailing address:
  • Phone: 740-773-4366
  • Fax: 740-775-7855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34004541
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: