Healthcare Provider Details

I. General information

NPI: 1669630893
Provider Name (Legal Business Name): TAI E VALLIERE-WHITE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 07/04/2022
Certification Date: 07/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

688 SPRING ST NW
ATLANTA GA
30308-1934
US

IV. Provider business mailing address

2727 PACES FERRY RD SE STE 1-1100
ATLANTA GA
30339-6151
US

V. Phone/Fax

Practice location:
  • Phone: 678-422-8824
  • Fax:
Mailing address:
  • Phone: 770-922-4024
  • Fax: 770-229-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number072510
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number072510
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: