Healthcare Provider Details

I. General information

NPI: 1477928448
Provider Name (Legal Business Name): TOSHA MICHELLE WHITE AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TOSHA MICHELLE GARRETT

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 JOHN MADDOX DR NW STE B
ROME GA
30165-1477
US

IV. Provider business mailing address

PO BOX 12938 C/O CLINIC MANAGEMENT
CALHOUN GA
30703
US

V. Phone/Fax

Practice location:
  • Phone: 706-368-8500
  • Fax: 706-307-4613
Mailing address:
  • Phone: 706-602-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-NP216438
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: