Healthcare Provider Details

I. General information

NPI: 1508599002
Provider Name (Legal Business Name): COURTNEY WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WADE WHITE

II. Dates (important events)

Enumeration Date: 07/03/2022
Last Update Date: 07/03/2022
Certification Date: 07/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11705 MERCY BLVD
SAVANNAH GA
31419-1791
US

IV. Provider business mailing address

401 BUCKHALTER RD
SAVANNAH GA
31405-6113
US

V. Phone/Fax

Practice location:
  • Phone: 912-819-4100
  • Fax:
Mailing address:
  • Phone: 912-258-1022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: