Provider Demographics
NPI:1811924384
Name:WHITNEY PA, DOUGLAS TERRY (PA-C)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:TERRY
Last Name:WHITNEY PA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:FAISON
Mailing Address - State:NC
Mailing Address - Zip Code:28341-0187
Mailing Address - Country:US
Mailing Address - Phone:910-267-2042
Mailing Address - Fax:855-996-9090
Practice Address - Street 1:408 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2312
Practice Address - Country:US
Practice Address - Phone:910-267-8933
Practice Address - Fax:910-267-8933
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY000651363AM0700X
NC100152363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY540957Medicare UPIN
NCNC2836BMedicare PIN