Healthcare Provider Details

I. General information

NPI: 1023166881
Provider Name (Legal Business Name): EDDIE VERNON WHITE C.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3224 LAKE WOODARD DR SUITE 100
RALEIGH NC
27604-3659
US

IV. Provider business mailing address

3224 LAKE WOODARD DR SUITE 100
RALEIGH NC
27604-3659
US

V. Phone/Fax

Practice location:
  • Phone: 919-231-6890
  • Fax: 919-231-3490
Mailing address:
  • Phone: 919-231-6890
  • Fax: 919-231-3490

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: