Provider Demographics
NPI:1265784268
Name:WHIGHAM, GREGORY CALEB (CRNA)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:CALEB
Last Name:WHIGHAM
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N EDWARDS ST
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-2510
Mailing Address - Country:US
Mailing Address - Phone:334-347-0584
Mailing Address - Fax:334-347-2080
Practice Address - Street 1:1108 ROSS CLARK CIR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3022
Practice Address - Country:US
Practice Address - Phone:334-793-8087
Practice Address - Fax:334-793-8191
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1120381163W00000X
AL1-120381367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse