Healthcare Provider Details

I. General information

NPI: 1710440318
Provider Name (Legal Business Name): STEPHEN FRANKLIN WHITE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 08/26/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 DEPUTY BILL CANTRELL MEMORIAL ROAD SUITE 260
CUMMING GA
30040-3021
US

IV. Provider business mailing address

4150 DEPUTY BILL CANTRELL MEMORIAL ROAD SUITE 260
CUMMING GA
30040-3021
US

V. Phone/Fax

Practice location:
  • Phone: 770-292-3045
  • Fax: 770-292-3046
Mailing address:
  • Phone: 770-292-3045
  • Fax: 770-292-3046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number103714
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: