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NPI Code Detail

MEDICARE: DR. JORDAN STUART WHATLEY M.D.

MEDICARE: DR. JORDAN STUART WHATLEY M.D.
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
1208000000XPediatrics Physician4301105294MI
22080P0206XPediatric Gastroenterology PhysicianA148950CA
32080P0206XPediatric Gastroenterology Physician84088SC

General Provider Information

NPI Number : 1194139337
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JORDAN STUART WHATLEY M.D.
Provider Business Mailing Address
First Line : PO BOX 751461
Second Line :
City : CHARLOTTE
State : NC
Zip : 28275-1461
Country : US
Telephone Number : 843-792-6200
Fax Number :
Provider Business Practice Location Address
First Line : 2250 MALL DR
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29406-6563
Country : US
Telephone Number : 843-876-0444
Fax Number : 310-206-0203
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2014
Last Update Date : 09/15/2020

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