Healthcare Provider Details

I. General information

NPI: 1275517989
Provider Name (Legal Business Name): RAMONA TAYLOR WHITE MSW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4994 LOWER ROSWELL RD
MARIETTA GA
30068-4332
US

IV. Provider business mailing address

3315 VALLEY RD NW
ATLANTA GA
30305-1150
US

V. Phone/Fax

Practice location:
  • Phone: 770-977-2987
  • Fax: 638-236-6041
Mailing address:
  • Phone: 404-261-1080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberGA000436
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: