Provider Demographics
NPI:1568620060
Name:WHITESBURG FAMILY MEDICINE
Entity Type:Organization
Organization Name:WHITESBURG FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-327-0888
Mailing Address - Street 1:4800 WHITESPORT CIR SW STE 1
Mailing Address - Street 2:STE. 201
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6444
Mailing Address - Country:US
Mailing Address - Phone:256-327-0888
Mailing Address - Fax:256-327-0891
Practice Address - Street 1:4800 WHITESPORT CIR SW STE 1
Practice Address - Street 2:STE. 201
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6444
Practice Address - Country:US
Practice Address - Phone:256-327-0888
Practice Address - Fax:256-327-0891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27081207Q00000X
AL27651207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty