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General NPI Number Information
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NPI Number | 1699707638
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Entity Type | Individual
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Provider Name | JOHN R WHITWORTH M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 806 ESTATE PL
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City | MEMPHIS
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State | TN
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Zip | 38120-0600
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Country | US
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Telephone | 901-681-4017
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Fax | 901-681-4013
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Provider Business Mailing Address
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Address Line | 2670 UNION AVENUE EXT SUITE 1220
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City | MEMPHIS
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State | TN
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Zip | 38112-4426
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Country | US
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Telephone | 901-458-9785
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Fax | 901-458-8192
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | 34143
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License Number State | TN
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