Healthcare Provider Details

I. General information

NPI: 1720036890
Provider Name (Legal Business Name): SHELBY T WHITE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 HIGHWAY 24 E STE A
CENTREVILLE MS
39631-4171
US

IV. Provider business mailing address

178 HIGHWAY 24 E STE A
CENTREVILLE MS
39631-4171
US

V. Phone/Fax

Practice location:
  • Phone: 601-890-0520
  • Fax: 601-645-5788
Mailing address:
  • Phone: 601-890-0520
  • Fax: 601-645-5788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36465
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: