Provider Demographics
NPI:1245213545
Name:WHALEY, NATHANIEL ROBB (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:ROBB
Last Name:WHALEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:N.
Other - Middle Name:R
Other - Last Name:WHALEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1321 SUNSET DRIVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-7902
Mailing Address - Country:US
Mailing Address - Phone:423-928-6174
Mailing Address - Fax:423-926-2258
Practice Address - Street 1:1321 SUNSET DRIVE
Practice Address - Street 2:SUITE 11
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-7902
Practice Address - Country:US
Practice Address - Phone:423-928-6174
Practice Address - Fax:423-926-2258
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME916232084N0400X
TNMD444902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology