Provider Demographics
NPI:1134574429
Name:WHITAKER, ADAM L (DO)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:L
Last Name:WHITAKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W WINGATE RD
Mailing Address - Street 2:
Mailing Address - City:NEW AUGUSTA
Mailing Address - State:MS
Mailing Address - Zip Code:39462-9740
Mailing Address - Country:US
Mailing Address - Phone:601-964-3640
Mailing Address - Fax:
Practice Address - Street 1:150 REYNOIR ST
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-4130
Practice Address - Country:US
Practice Address - Phone:228-432-1571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS26860207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine