Provider Demographics
NPI:1871596767
Name:WHITLEDGE, JOSHUA DREW (DO)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:DREW
Last Name:WHITLEDGE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH FULTON
Mailing Address - State:TN
Mailing Address - Zip Code:38257-2835
Mailing Address - Country:US
Mailing Address - Phone:731-479-2606
Mailing Address - Fax:731-479-2610
Practice Address - Street 1:1135 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SOUTH FULTON
Practice Address - State:TN
Practice Address - Zip Code:38257-2835
Practice Address - Country:US
Practice Address - Phone:731-479-2606
Practice Address - Fax:731-479-2610
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02888207Q00000X
TN02720207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4047266Medicaid
TN103I089052OtherMEDICARE B-TN
KY64111669Medicaid
TN4047266Medicaid
TN4047266Medicaid