Provider Demographics
NPI:1194055301
Name:WHITEHURST, MARGARET M (PA)
Entity type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:M
Last Name:WHITEHURST
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:MARGARET
Other - Middle Name:
Other - Last Name:MCCRARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1084 INDUSTRIAL PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:SARALAND
Mailing Address - State:AL
Mailing Address - Zip Code:36571-3726
Mailing Address - Country:US
Mailing Address - Phone:251-675-5034
Mailing Address - Fax:251-675-8511
Practice Address - Street 1:1084 INDUSTRIAL PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-3726
Practice Address - Country:US
Practice Address - Phone:251-675-5034
Practice Address - Fax:251-675-8511
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL260388923OtherTAX ID
AL511-02389OtherBCBS ALABAMA