1568468809 NPI number — MRS. CHRISTIE R WHITE PA-C

Table of content: MRS. CHRISTIE R WHITE PA-C (NPI 1568468809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568468809 NPI number — MRS. CHRISTIE R WHITE PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITE
Provider First Name:
CHRISTIE
Provider Middle Name:
R
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568468809
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
318 TRIBBLE GAP RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUMMING
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30040-2440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-889-8240
Provider Business Mailing Address Fax Number:
678-539-0625

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3929 CARTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFORD
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30518-1628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-271-9855
Provider Business Practice Location Address Fax Number:
770-886-6806
Provider Enumeration Date:
06/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  PA3557 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 6821 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003116100F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64384 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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