1821049347 NPI number — MR. JAMES WILLIAM WHITE JR. CRNA

Table of content: MS. PATTY A O'CONNELL LCSW (NPI 1902180417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821049347 NPI number — MR. JAMES WILLIAM WHITE JR. CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITE
Provider First Name:
JAMES
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
CRNA
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:
1821049347
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
866 WOOTEN LAKE RD NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNESAW
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30144-1339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-517-4819
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1362 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLIJAY
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30540-5410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-276-4741
Provider Business Practice Location Address Fax Number:
706-276-4645
Provider Enumeration Date:
05/12/2006

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: 367500000X , with the licence number:  RN124549 , 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: 110205 . This is a "MEDICARE PART A PROVIDER NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 115683 . This is a "GILMER NURSING HOME MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: HOSP34 . This is a "MEDICARE PART B PROVIDER NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 190963580 . This is a "GILMER NURSING HOME NPI NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 11U205 . This is a "MEDICARE SWING BED PROVIDER NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1275690703 . This is a "NORTH GEORGIA MEDICAL CENTER SWING BED NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 628576069B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000002043A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1952395097 . This is a "NPI NORTH GEORGIA MEDICAL CENTER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 115211400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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