Healthcare Provider Details

I. General information

NPI: 1962415117
Provider Name (Legal Business Name): JOHN W. WHITE, JR., MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 02/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 PALMETTO ROAD
VERONA MS
38879-0429
US

IV. Provider business mailing address

PO BOX 429 1423 PALMETTO ROAD
VERONA MS
38879-0429
US

V. Phone/Fax

Practice location:
  • Phone: 662-566-5593
  • Fax: 662-566-4419
Mailing address:
  • Phone: 662-566-5593
  • Fax: 662-566-4419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number StateMS

VIII. Authorized Official

Name: AMANDA K CRANE
Title or Position: CLINIC MANAGER
Credential:
Phone: 662-566-5593