Healthcare Provider Details

I. General information

NPI: 1972587020
Provider Name (Legal Business Name): SANDRA LAFOREST WHITE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 CUMBERLAND PKWY SE SUITE 3311
ATLANTA GA
30339-6136
US

IV. Provider business mailing address

4532 KINVARRA CIR SW
MABLETON GA
30126-1493
US

V. Phone/Fax

Practice location:
  • Phone: 404-304-9929
  • Fax:
Mailing address:
  • Phone: 404-304-8218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number020362
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: