Healthcare Provider Details

I. General information

NPI: 1609160001
Provider Name (Legal Business Name): PATRICIA WHITE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 06/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 FIRST STREET EXT
SPRINGFIELD GA
31329
US

IV. Provider business mailing address

3441 CYPRESS MILL RD SUITE 102
BRUNSWICK GA
31520-2878
US

V. Phone/Fax

Practice location:
  • Phone: 912-754-3030
  • Fax:
Mailing address:
  • Phone: 912-264-0979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN035832
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: