Healthcare Provider Details

I. General information

NPI: 1215904644
Provider Name (Legal Business Name): MARSHALL NEIL WHITE III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 SAINT VINCENTS DR
BIRMINGHAM AL
35205-1601
US

IV. Provider business mailing address

810 SAINT VINCENTS DR
BIRMINGHAM AL
35205-1601
US

V. Phone/Fax

Practice location:
  • Phone: 205-930-2456
  • Fax: 205-930-2469
Mailing address:
  • Phone: 205-930-2456
  • Fax: 205-930-2469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number00017471
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number14747
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: