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General NPI Number Information
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NPI Number | 1609919836
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Entity Type | Organization
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Legal Business Name | JCWHIT P.A.
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2713 S 74TH ST SUITE 408
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City | FORT SMITH
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State | AR
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Zip | 72903-5170
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Country | US
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Telephone | 479-484-5646
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Fax |
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Provider Business Mailing Address
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Address Line | 2713 S 74TH ST SUITE 408
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City | FORT SMITH
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State | AR
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Zip | 72903-5170
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Country | US
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Telephone | 479-484-5646
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JOHN C WHITAKER
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Credential | M.D.
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Telephone | 479-484-5645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | C-7165
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License Number State | AR
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