Provider Demographics
NPI:1467510123
Name:WHATLEY, WILLIAM L JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:L
Last Name:WHATLEY
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:L
Other - Last Name:WHATLEY
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DMD PC
Mailing Address - Street 1:2487 DEMERE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-5639
Mailing Address - Country:US
Mailing Address - Phone:912-638-9302
Mailing Address - Fax:
Practice Address - Street 1:2487 DEMERE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-5639
Practice Address - Country:US
Practice Address - Phone:912-638-9302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA108311223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00458807AMedicaid