Provider Demographics
NPI:1972663136
Name:WILLIAM L WHATLEY D.M.D. P.C.
Entity Type:Organization
Organization Name:WILLIAM L WHATLEY D.M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:WHATLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:912-638-9302
Mailing Address - Street 1:2487 DEMERE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-5639
Mailing Address - Country:US
Mailing Address - Phone:912-638-9302
Mailing Address - Fax:
Practice Address - Street 1:2487 DEMERE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-5639
Practice Address - Country:US
Practice Address - Phone:912-638-9302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA108311223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00458807AMedicaid