Healthcare Provider Details

I. General information

NPI: 1922003953
Provider Name (Legal Business Name): BARRY WHITES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 N STATE ST STE 617
JACKSON MS
39202-2407
US

IV. Provider business mailing address

1151 N STATE ST STE 617
JACKSON MS
39202-2407
US

V. Phone/Fax

Practice location:
  • Phone: 601-352-5864
  • Fax: 601-352-5867
Mailing address:
  • Phone: 601-352-5864
  • Fax: 601-352-5867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number06787
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: