Provider Demographics
NPI:1679690523
Name:WITTY, JR., JOSEPH BINGHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:BINGHAM
Last Name:WITTY, JR.
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 5TH ST N
Mailing Address - Street 2:SUITE 1
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2222
Mailing Address - Country:US
Mailing Address - Phone:662-329-1393
Mailing Address - Fax:662-329-9864
Practice Address - Street 1:2102 5TH ST N
Practice Address - Street 2:SUITE 1
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2222
Practice Address - Country:US
Practice Address - Phone:662-329-1393
Practice Address - Fax:662-329-9864
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10522207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00019353Medicaid
MSB60565Medicare UPIN