Provider Demographics
NPI:1497059828
Name:WHITLEY, JANICE L (CFO)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:L
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:CFO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 192
Mailing Address - Street 2:107 MOSS SPRINGS RD
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28002-0192
Mailing Address - Country:US
Mailing Address - Phone:704-983-6770
Mailing Address - Fax:704-983-6160
Practice Address - Street 1:107 MOSS SPRINGS RD
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-5140
Practice Address - Country:US
Practice Address - Phone:704-983-6770
Practice Address - Fax:704-983-6160
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7795213335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795213Medicaid
NC5132230001OtherNPI FOR MEDICARE 1639135536