Healthcare Provider Details

I. General information

NPI: 1972439420
Provider Name (Legal Business Name): WHITLEY CAGLE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2306 KNOB CREEK RD STE 106
JOHNSON CITY TN
37604-2366
US

IV. Provider business mailing address

375 SALT LN
SAVANNAH TN
38372-7664
US

V. Phone/Fax

Practice location:
  • Phone: 423-929-3140
  • Fax:
Mailing address:
  • Phone: 731-727-6796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4012
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: