Provider Demographics
NPI:1447245931
Name:WHITWORTH, JAMES D (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:WHITWORTH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 BOATNER RD
Mailing Address - Street 2:STE 114, FAMILY MEDICINE RESIDENCY
Mailing Address - City:EGLIN AFB
Mailing Address - State:FL
Mailing Address - Zip Code:32542-1391
Mailing Address - Country:US
Mailing Address - Phone:850-883-8173
Mailing Address - Fax:850-883-2468
Practice Address - Street 1:307 BOATNER RD
Practice Address - Street 2:STE 114, FAMILY MEDICINE RESIDENCY
Practice Address - City:EGLIN AFB
Practice Address - State:FL
Practice Address - Zip Code:32542-1391
Practice Address - Country:US
Practice Address - Phone:850-883-8173
Practice Address - Fax:850-883-2468
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW45551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical