Provider Demographics
NPI:1093172652
Name:M D WHITEST MEDICAL INSTITUTE INC
Entity Type:Organization
Organization Name:M D WHITEST MEDICAL INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:WHITEST
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:404-751-7207
Mailing Address - Street 1:401 N 15TH ST
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-2932
Mailing Address - Country:US
Mailing Address - Phone:404-751-7207
Mailing Address - Fax:
Practice Address - Street 1:401 N 15TH ST
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-2932
Practice Address - Country:US
Practice Address - Phone:404-751-7207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health