Provider Demographics
NPI:1205818242
Name:WHITLEY, WILLIAM DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DAVID
Last Name:WHITLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:817 PRINCETON AVE SW
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-1333
Mailing Address - Country:US
Mailing Address - Phone:205-939-3495
Mailing Address - Fax:205-918-0147
Practice Address - Street 1:2660 10TH AVE S
Practice Address - Street 2:SUITE 608
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1605
Practice Address - Country:US
Practice Address - Phone:205-939-3495
Practice Address - Fax:205-918-0147
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000210352086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009917395Medicaid
AL51528789OtherBLUE CROSS
AL009931858Medicaid
AL009917415Medicaid
AL3710038OtherMEDICARE COMPLETE
AL51512731OtherBLUE CROSS
AL009917405Medicaid
AL90653OtherUMWA
ALG31908OtherSENIORS FIRST
AL009917385Medicaid
AL020053731OtherPALMETTO GOVERN. BENEFITS
ALG31908OtherVIVA HEALTH CARE
AL12731WHIOtherCHAMPUS
AL3710038OtherUNITEDHEALTH CARE
ALG31908OtherHEALTH SPRINGS
AL009931858Medicaid
AL009917415Medicaid
AL009917395Medicaid