Provider Demographics
NPI:1225065048
Name:SLADE, WHITNEY THOMPSON (MD)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:THOMPSON
Last Name:SLADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:DEPARTMENT 978
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148
Mailing Address - Country:US
Mailing Address - Phone:901-756-5565
Mailing Address - Fax:901-756-5564
Practice Address - Street 1:4901 RALEIGH COMMONS DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128
Practice Address - Country:US
Practice Address - Phone:901-387-0193
Practice Address - Fax:901-384-1645
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000020005207R00000X
TNMD020005207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4290300OtherBCBS
TN0129504OtherBLUECROSS OF TENNESSEE
TN3050475Medicaid
TNE61511Medicare UPIN
TN103I110160Medicare PIN
TN3050475Medicaid