MEDICARE: DR. NATHANIEL ROBB WHALEY MD

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	2084N0400X	Neurology Physician	ME91623	FL
2	2084N0400X	Neurology Physician	MD44490	TN

General Provider Information

NPI Number	:	1245213545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHANIEL ROBB WHALEY MD

Provider Business Mailing Address
First Line	:	1321 SUNSET DRIVE
Second Line	:	SUITE 11
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-7902
Country	:	US
Telephone Number	:	423-928-6174
Fax Number	:	423-926-2258

Provider Business Practice Location Address
First Line	:	1321 SUNSET DRIVE
Second Line	:	SUITE 11
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-7902
Country	:	US
Telephone Number	:	423-928-6174
Fax Number	:	423-926-2258

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

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	03/08/2016

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