Organization
WHITAKER MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MACKENZIE NICHOLS (PHYSICIAN ASSISTANT)
(575) 318-6833
Entity
Organization
Contact information
Practice address
525 MADISON ST SE, SUITE 203, HUNTSVILLE, AL 35801-4268
(866) 830-9002
Mailing address
525 MADISON ST SE, SUITE 203, HUNTSVILLE, AL 35801-4268
(866) 830-9002
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
TX
Other
Enumeration date
10/08/2010
Last updated
10/08/2010
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