Provider Demographics
NPI:1831133958
Name:WHATLEY HEALTH SERVICES INC
Entity Type:Organization
Organization Name:WHATLEY HEALTH SERVICES INC
Other - Org Name:EUTAW HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:205-758-6647
Mailing Address - Street 1:PO BOX 2400
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35403-2400
Mailing Address - Country:US
Mailing Address - Phone:205-758-6647
Mailing Address - Fax:205-345-3993
Practice Address - Street 1:200 MORROW AVE
Practice Address - Street 2:
Practice Address - City:EUTAW
Practice Address - State:AL
Practice Address - Zip Code:35462-1106
Practice Address - Country:US
Practice Address - Phone:205-372-0011
Practice Address - Fax:205-372-9079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630004005Medicaid