Provider Demographics
NPI:1336358100
Name:WHITESIDE, CARL THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:THOMAS
Last Name:WHITESIDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CARL
Other - Middle Name:THOMAS
Other - Last Name:WHITESIDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:228 OLD HAW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-1910
Mailing Address - Country:US
Mailing Address - Phone:828-337-4878
Mailing Address - Fax:
Practice Address - Street 1:70 WOODFIN PL
Practice Address - Street 2:STE 130
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2463
Practice Address - Country:US
Practice Address - Phone:828-337-4878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC164802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry