Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | LL34829 | SC |
N | 111NI0900X | Internist | LL34829 | SC |
Y | 207W00000X | Ophthalmologist | 24793 | MS |
N | 207W00000X | Ophthalmologist | 25993 | WV |
NPI | 1003170036 |
---|---|
Provider Name | Mr. Alexander Chapman Whittington |
First Address | Jackson, MS 39202-2027 |
Second Address | Madison, MS 39110-2009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2012 |
Last Update Date | 18/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09689299 | (05) | MS |