Healthcare Provider Details

I. General information

NPI: 1548789134
Provider Name (Legal Business Name): SANTIANNA NISHONDRA WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 16TH AVE APT 6
ALBANY GA
31701
US

IV. Provider business mailing address

2303 DAWSON RD STE 102
ALBANY GA
31707-2718
US

V. Phone/Fax

Practice location:
  • Phone: 229-288-1896
  • Fax:
Mailing address:
  • Phone: 404-721-2238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: