=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790754307
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM D WHITTON MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2006
-----------------------------------------------------
Last Update Date | 03/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1040 GLUCKSTADT RD STE B
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39110-7228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-605-0452
-----------------------------------------------------
Fax | 601-605-0453
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 140 COLONY PL
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39110-6638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-918-2368
-----------------------------------------------------
Fax | 601-605-0453
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 15902
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------