Healthcare Provider Details

I. General information

NPI: 1801882634
Provider Name (Legal Business Name): JOHN A WHITE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 FRONT ST SUITE 240
VIDALIA LA
71373-2836
US

IV. Provider business mailing address

506 S UNION ST
NATCHEZ MS
39120-3578
US

V. Phone/Fax

Practice location:
  • Phone: 318-336-2214
  • Fax: 318-336-6069
Mailing address:
  • Phone: 601-446-7524
  • Fax: 318-336-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number017462
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: