MEDICARE: DR. RONALD WHITTINGTON D.P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2013	MS

General Provider Information

NPI Number	:	1023484888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD WHITTINGTON D.P.C.

Provider Business Mailing Address
First Line	:	PO BOX 2412
Second Line	:
City	:	MADISON
State	:	MS
Zip	:	39130-2412
Country	:	US
Telephone Number	:	601-707-7197
Fax Number	:	601-707-7292

Provider Business Practice Location Address
First Line	:	357 TOWNE CENTER BLVD., STE 203
Second Line	:
City	:	RIDGELAND
State	:	MS
Zip	:	39157-4837
Country	:	US
Telephone Number	:	601-707-7197
Fax Number	:	601-707-7292

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2015
Last Update Date	:	03/06/2017

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