1215001144 NPI number — HORACE ROGER WHITE M.D.

Table of content: HORACE ROGER WHITE M.D. (NPI 1215001144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215001144 NPI number — HORACE ROGER WHITE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITE
Provider First Name:
HORACE
Provider Middle Name:
ROGER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1215001144
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1660 CAVAN DR SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30064-2942
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-424-1782
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
49 S MARIETTA PKWY SW
Provider Second Line Business Practice Location Address:
#C
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30064-3288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-424-0647
Provider Business Practice Location Address Fax Number:
770-590-5990
Provider Enumeration Date:
11/20/2006

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:  16447 , 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: 582142384 . This is a "TRICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 00193223F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110092128 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1215001144 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 5986187 . This is a "CIGNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 582142384 . This is a "MAIL HANDLERS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 124860510967 . This is a "HUMANA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 4231143 . This is a "AETNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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