Individual
DR. JACK H WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1410 TUSCULUM BLVD.,, SUITE 1500, GREENEVILLE, TN 37745
(423) 638-2270
(423) 928-0219
Mailing address
105 W STONE DR, SUITE 6A, KINGSPORT, TN 37660-3365
(423) 408-7220
(423) 408-7405
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
0101245897
VA
207RC0000X
Cardiovascular Disease Physician
Primary
20931
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3078282
—
TN
01
—
4082722
BCBS
TN
01
—
TN01S2
JOHN DEERE
TN
Enumeration date
04/26/2006
Last updated
10/28/2024
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