Provider Demographics
NPI:1609070788
Name:WHITEHALL MEDICAL CENTER
Entity Type:Organization
Organization Name:WHITEHALL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-234-7000
Mailing Address - Street 1:PO BOX 1365
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-1365
Mailing Address - Country:US
Mailing Address - Phone:706-234-7000
Mailing Address - Fax:706-234-2366
Practice Address - Street 1:1011 N 5TH AVE NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2601
Practice Address - Country:US
Practice Address - Phone:706-234-7000
Practice Address - Fax:706-234-2366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1401111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAX ID
GA103213Medicare ID - Type Unspecified