Provider Demographics
NPI:1114101383
Name:WHATLEY HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:WHATLEY HEALTH SERVICES, INC
Other - Org Name:VERNON HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:GAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:205-758-6647
Mailing Address - Street 1:2731 MLK JR BLVD
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-5235
Mailing Address - Country:US
Mailing Address - Phone:205-349-3250
Mailing Address - Fax:205-345-3993
Practice Address - Street 1:230 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:AL
Practice Address - Zip Code:35592-5251
Practice Address - Country:US
Practice Address - Phone:205-695-0450
Practice Address - Fax:205-695-0451
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHATLEY HEALTH SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-24
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630011005Medicaid