Healthcare Provider Details

I. General information

NPI: 1891209227
Provider Name (Legal Business Name): CALEB SIMS WHITNEY ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 SC 707
MURRELLS INLET SC
29576
US

IV. Provider business mailing address

8969 POLO CIR
MURRELLS INLET SC
29576-8384
US

V. Phone/Fax

Practice location:
  • Phone: 843-650-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number2060
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: