Healthcare Provider Details

I. General information

NPI: 1659877579
Provider Name (Legal Business Name): JESSICA JUDITH WHITE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 GRIFFIN AVE
VALDOSTA GA
31601-6331
US

IV. Provider business mailing address

520 GRIFFIN AVE
VALDOSTA GA
31601-6331
US

V. Phone/Fax

Practice location:
  • Phone: 229-245-0020
  • Fax:
Mailing address:
  • Phone: 229-245-0020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number88560
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: