Healthcare Provider Details

I. General information

NPI: 1134433691
Provider Name (Legal Business Name): SHEENA WHITE MS, MMSC-PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 01/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 BILL KENNEDY WAY SE
ATLANTA GA
30316-6835
US

IV. Provider business mailing address

490 BILL KENNEDY WAY SE
ATLANTA GA
30316-6835
US

V. Phone/Fax

Practice location:
  • Phone: 404-446-4726
  • Fax:
Mailing address:
  • Phone: 404-446-4726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberATH.200124
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: