Healthcare Provider Details

I. General information

NPI: 1093649428
Provider Name (Legal Business Name): MR. HAROLD WILLIAM WHITE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 WYNDMONT WAY
COVINGTON GA
30014-7905
US

IV. Provider business mailing address

15 WYNDMONT WAY
COVINGTON GA
30014-7905
US

V. Phone/Fax

Practice location:
  • Phone: 404-981-4625
  • Fax:
Mailing address:
  • Phone: 404-981-4625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: