Healthcare Provider Details

I. General information

NPI: 1679530778
Provider Name (Legal Business Name): TONI M WHITAKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N DUNLAP ST STE 400
MEMPHIS TN
38105-4625
US

IV. Provider business mailing address

920 MADISON AVE SUITE 939
MEMPHIS TN
38163-5003
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-7337
  • Fax: 901-448-6511
Mailing address:
  • Phone: 901-448-6511
  • Fax: 901-448-6511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number27610
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: