Provider Demographics
NPI:1750776415
Name:WHITMORE, CHARLES ALBERT (MD, MPH)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ALBERT
Last Name:WHITMORE
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:1310 24TH AVE. S.
Mailing Address - Street 2:A-116
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212
Mailing Address - Country:US
Mailing Address - Phone:615-327-4751
Mailing Address - Fax:615-873-7021
Practice Address - Street 1:1310 24TH AVE. S.
Practice Address - Street 2:A-116
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212
Practice Address - Country:US
Practice Address - Phone:615-327-4751
Practice Address - Fax:615-873-7021
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN580362084P0804X, 2084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program