1982633848 NPI number — JAMES A WHITLEY, DDS PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982633848 NPI number — JAMES A WHITLEY, DDS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES A WHITLEY, DDS PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982633848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
309 W MILLBROOK RD
Provider Second Line Business Mailing Address:
SUITE 181
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27609-4385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-789-0400
Provider Business Mailing Address Fax Number:
919-789-0440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
309 W MILLBROOK RD
Provider Second Line Business Practice Location Address:
SUITE 181
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27609-4385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-789-0400
Provider Business Practice Location Address Fax Number:
919-789-0440
Provider Enumeration Date:
07/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WHITLEY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
ARTHUR
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
919-789-0400

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  NC 5430 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5430 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 99245 . This is a "BCBSNC IDENTIFIER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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