Provider Demographics
NPI:1790754307
Name:WHITTON, WILLIAM D (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:D
Last Name:WHITTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:140 COLONY PL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6638
Mailing Address - Country:US
Mailing Address - Phone:601-918-2368
Mailing Address - Fax:601-605-0453
Practice Address - Street 1:1040 GLUCKSTADT RD STE B
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-7228
Practice Address - Country:US
Practice Address - Phone:601-605-0452
Practice Address - Fax:601-605-0453
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15902207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00169813OtherRR MEDICARE
MS753068151OtherMS PHYSCIANS CARE NETWORK
MS753068151OtherFIRST CHOICE
MS00122387Medicaid
MS7610132OtherAETNA
MS168390707OtherUS DEPT OF LABOR
MS753068151001OtherTRICARE
MS753068151OtherMS HEALTH PARTNERS
MS753068151Other1ST CHOICE
MS7610132OtherAETNA
MS080003986Medicare ID - Type Unspecified