Organization
WHATLEY HEALTH SERVICES INC
Active
Parent organization
WHATLEY HEALTH SERVICES, INC
Other names
LaBridgette R. Ellis Medical and Dental Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
WHATLEY HEALTH SERVICES, INC
Authorized official
DAVID GAY JR. (CEO)
(205) 758-6647
Entity
Organization
Contact information
Practice address
800 HALL ST, GREENSBORO, AL 36744
(334) 624-7270
(334) 624-0872
Mailing address
2731 MLK JR BLVD, TUSCALOOSA, AL 35401-5235
(205) 349-3250
(205) 345-3993
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
630006005
—
AL
01
—
I747
MEDICARE GROUP NUMBER
AL
Enumeration date
07/21/2006
Last updated
05/17/2022
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