Provider Demographics
NPI:1235410556
Name:MILLARD H. MCWHORTER III MD PC
Entity Type:Organization
Organization Name:MILLARD H. MCWHORTER III MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MILLARD
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:MCWHORTER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:334-222-4251
Mailing Address - Street 1:PO BOX 1457
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-1225
Mailing Address - Country:US
Mailing Address - Phone:334-222-4251
Mailing Address - Fax:334-428-2056
Practice Address - Street 1:408 S THREE NOTCH ST
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-4407
Practice Address - Country:US
Practice Address - Phone:334-222-4251
Practice Address - Fax:334-428-2056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12674261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009967340Medicaid
AL009967340Medicaid