Provider Demographics
NPI:1366678427
Name:WHITEHURST GENERAL SURGERY PC
Entity Type:Organization
Organization Name:WHITEHURST GENERAL SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:BRAY
Authorized Official - Last Name:WHITEHURST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-671-5050
Mailing Address - Street 1:112 HAVEN DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-2907
Mailing Address - Country:US
Mailing Address - Phone:334-671-5050
Mailing Address - Fax:334-671-5070
Practice Address - Street 1:112 HAVEN DR
Practice Address - Street 2:SUITE 1
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-2907
Practice Address - Country:US
Practice Address - Phone:334-671-5050
Practice Address - Fax:334-671-5070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty