Healthcare Provider Details

I. General information

NPI: 1568438612
Provider Name (Legal Business Name): NETTIE M WHITE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 MOUNTAIN VIEW RD
MARS HILL NC
28754-9500
US

IV. Provider business mailing address

PO BOX 69
MARSHALL NC
28753-0069
US

V. Phone/Fax

Practice location:
  • Phone: 828-689-3507
  • Fax: 828-689-3505
Mailing address:
  • Phone: 828-649-9566
  • Fax: 828-649-3786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27538
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number27538
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: