Provider Demographics
NPI:1467874354
Name:WHATLEY HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:WHATLEY HEALTH SERVICES, INC
Other - Org Name:PICKENS COUNTY FAMILY PRACTICE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:GAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:205-758-6647
Mailing Address - Street 1:2731 MLK JR BLVD
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-5235
Mailing Address - Country:US
Mailing Address - Phone:205-349-3250
Mailing Address - Fax:205-345-3993
Practice Address - Street 1:27340 HIGHWAY 86
Practice Address - Street 2:
Practice Address - City:GORDO
Practice Address - State:AL
Practice Address - Zip Code:35466-3578
Practice Address - Country:US
Practice Address - Phone:205-364-7135
Practice Address - Fax:205-364-8244
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHATLEY HEALTH SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-10
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)