Healthcare Provider Details

I. General information

NPI: 1982997805
Provider Name (Legal Business Name): BRETT WHITE CP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 06/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 FAIRGROVE CHURCH RD SE STE 203
CONOVER NC
28613-9290
US

IV. Provider business mailing address

1687 NELSON DR
NEWTON NC
28658-1516
US

V. Phone/Fax

Practice location:
  • Phone: 828-328-5347
  • Fax: 828-328-4405
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: