Basic Information
| Provider Information | |||||||||
| NPI: | 1023338183 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHELAN | ||||||||
| FirstName: | JACOB | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 405827 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303845827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012274068 | ||||||||
| FaxNumber: | 9012278591 | ||||||||
| Practice Location | |||||||||
| Address1: | 2301 SOUTH LAMAR BLVD. | ||||||||
| Address2: | |||||||||
| City: | OXFORD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 38655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622328568 | ||||||||
| FaxNumber: | 6625131450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2010 | ||||||||
| LastUpdateDate: | 10/15/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | LL32691 | SC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 22577 | MS | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 22577 | MS | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.