Provider Demographics
NPI:1588292676
Name:WHITEHEAD, CALEB
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:
Last Name:WHITEHEAD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 N HICKORY ST STE E
Mailing Address - Street 2:
Mailing Address - City:LOXLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36551-2412
Mailing Address - Country:US
Mailing Address - Phone:251-620-4987
Mailing Address - Fax:
Practice Address - Street 1:2127 N HICKORY ST STE E
Practice Address - Street 2:
Practice Address - City:LOXLEY
Practice Address - State:AL
Practice Address - Zip Code:36551-2412
Practice Address - Country:US
Practice Address - Phone:251-620-4987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.2704207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine