Albert Whitaker,Jr. MD,PA
Organization Active NPI Clinic/Center · Gastonia, NC
NPI 1396003646 · NPPES record last updated Apr 24, 2012
Key facts
- NPI
- 1396003646
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- License
- 23244 (NC)
- Legal business name
- ALBERT WHITAKER,JR. MD,PA
- Practice address
- 224 S New Hope Rd
Suite K
Gastonia, NC 28054-4873 - Phone
- (704) 867-7494
- Fax
- (704) 867-7432
- NPI assigned
- Apr 24, 2012
- Organization subpart
- No
Authorized official
- Name
- Mrs. Jeannette Whitaker
- Title
- Business Administrator
- Phone
- (704) 867-7494
Practitioners 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D0723251 | Albert Whitaker Jr MD | Certificate of waiver | Dec 22, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130610000113 | NC | Part B Supplier - Clinic/Group Practice | 6507005295 |
Receives reassigned benefits from 1 practitioner Practice locations: Gastonia, NC |
National Provider Directory
Locations
224 S New Hope Rd
Ste K
Gastonia, NC 28054
Phone (704) 867-7494
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | 23244 | NC | Yes |
Addresses
Primary practice location
224 S New Hope Rd
Suite K
Gastonia, NC 28054-4873
Mailing address
224 S New Hope Rd
Suite K
Gastonia, NC 28054-4873
Phone (704) 867-7494
Other providers in Gastonia, NC
- Iyon Debbie Akhimien
- Funmilola Akingbala
- Cecilia Akintonde
- Joanne Frances Akong
- Alan a. Godel, D.D.S.
- Jessica Alberto
- Rosanna Albino
- Allison Aldridge
- Alex HD Pham DDS, PA
- Alexander Youth Network
All providers in Gastonia, NC · Clinic/Center in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.