Provider Demographics
NPI:1679530778
Name:WHITAKER, TONI M (MD)
Entity Type:Individual
Prefix:DR
First Name:TONI
Middle Name:M
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:920 MADISON AVE SUITE 939
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38163-5003
Mailing Address - Country:US
Mailing Address - Phone:901-448-6511
Mailing Address - Fax:901-448-6511
Practice Address - Street 1:51 N DUNLAP ST STE 400
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-4625
Practice Address - Country:US
Practice Address - Phone:901-287-7337
Practice Address - Fax:901-448-6511
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2021-08-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN276102080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H39021Medicare UPIN
TN3864841Medicare ID - Type Unspecified
3864841Medicare ID - Type Unspecified