Provider Demographics
NPI:1548301682
Name:WHITEHAVEN PEDIATRICS INC.
Entity type:Organization
Organization Name:WHITEHAVEN PEDIATRICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRAGLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-396-7518
Mailing Address - Street 1:4299 ELVIS PRESLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-6435
Mailing Address - Country:US
Mailing Address - Phone:901-398-7518
Mailing Address - Fax:901-398-3128
Practice Address - Street 1:4299 ELVIS PRESLEY BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6435
Practice Address - Country:US
Practice Address - Phone:901-398-7518
Practice Address - Fax:901-398-3128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty