Provider Demographics
NPI:1053401448
Name:WHALEY, RONALD CARL (DPH)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:CARL
Last Name:WHALEY
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 RAMSAY ST
Mailing Address - Street 2:
Mailing Address - City:ALCOA
Mailing Address - State:TN
Mailing Address - Zip Code:37701-2049
Mailing Address - Country:US
Mailing Address - Phone:865-984-6013
Mailing Address - Fax:
Practice Address - Street 1:152 BMH PHYSICIAN OFFICE BUILDING
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804
Practice Address - Country:US
Practice Address - Phone:865-983-9795
Practice Address - Fax:865-983-8758
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist