Healthcare Provider Details

I. General information

NPI: 1316964836
Provider Name (Legal Business Name): DOUGLAS W WHITE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5885 GLENRIDGE DR
ATLANTA GA
30328-5512
US

IV. Provider business mailing address

PO BOX 31665
CHARLOTTE NC
28231-1665
US

V. Phone/Fax

Practice location:
  • Phone: 843-572-4840
  • Fax:
Mailing address:
  • Phone: 843-793-6980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2002008192
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number101752
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number53356
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: