MEDICARE: MR. WILLIAM C WHITE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW005043	GA

General Provider Information

NPI Number	:	1396075230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM C WHITE LCSW

Provider Business Mailing Address
First Line	:	105 ROSWELL FARMS DR
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30075-4367
Country	:	US
Telephone Number	:	404-599-4609
Fax Number	:

Provider Business Practice Location Address
First Line	:	395 PRYOR ST SW
Second Line	:	SUITE 2142
City	:	ATLANTA
State	:	GA
Zip	:	30312-2713
Country	:	US
Telephone Number	:	404-613-4597
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2009
Last Update Date	:	01/02/2014

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