Healthcare Provider Details

I. General information

NPI: 1164074399
Provider Name (Legal Business Name): MR. STEPHEN J. WHITE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5775 PEACHTREE DUNWOODY RD SUITE 600 FL. 6 UHC HEARING
ATL. GA
30342
US

IV. Provider business mailing address

5775 PEACHTREE DUNWOODY RD SUITE 600 FL. 6 UHC HEARING
ATL. GA
30342
US

V. Phone/Fax

Practice location:
  • Phone: 404-748-3088
  • Fax:
Mailing address:
  • Phone: 404-748-3088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHADS000901
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: