1144772153 NPI number — LAURA SULLIVAN WHITE APN

Table of content: LAURA SULLIVAN WHITE APN (NPI 1144772153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144772153 NPI number — LAURA SULLIVAN WHITE APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITE
Provider First Name:
LAURA
Provider Middle Name:
SULLIVAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SULLIVAN
Provider Other First Name:
LAURA
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144772153
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7191 CAHABA VALLEY RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOOVER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35242-6461
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-405-7575
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7191 CAHABA VALLEY RD STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOOVER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35242-6461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-995-9909
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/26/2016

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: 363L00000X , with the licence number:  1-140447 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Q026597 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".