Provider Demographics
NPI:1336198548
Name:WHITAKER, FORREST SUTTON (MD)
Entity Type:Individual
Prefix:DR
First Name:FORREST
Middle Name:SUTTON
Last Name:WHITAKER
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 1:3351 S PEAK DR STE 101
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-9693
Mailing Address - Country:US
Mailing Address - Phone:910-908-4673
Mailing Address - Fax:910-908-2201
Practice Address - Street 1:3351 S PEAK DR STE 101
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-9693
Practice Address - Country:US
Practice Address - Phone:910-908-4673
Practice Address - Fax:910-908-2201
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49616208000000X
NC2013-01825208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics