1669630893 NPI number — DR. TAMICA E WHITE MD

Table of content: DR. TAMICA E WHITE MD (NPI 1669630893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669630893 NPI number — DR. TAMICA E WHITE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITE
Provider First Name:
TAMICA
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1669630893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2727 PACES FERRY RD SE STE 1-1100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30339-6151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-922-4024
Provider Business Mailing Address Fax Number:
770-229-2111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 SIGMAN RD NE STE 190
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONYERS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30012-3924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-922-4024
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2008

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: 208600000X , with the licence number:  072510 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2086X0206X , with the licence number: 072510 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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