Healthcare Provider Details

I. General information

NPI: 1275453243
Provider Name (Legal Business Name): CHRISTINE R WHITE SI,SC,IC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 N EDENFIELD RIDGE DR SE
ROME GA
30161-8708
US

IV. Provider business mailing address

176 N EDENFIELD RIDGE DR SE
ROME GA
30161-8708
US

V. Phone/Fax

Practice location:
  • Phone: 770-324-3399
  • Fax:
Mailing address:
  • Phone: 770-324-3399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: