Healthcare Provider Details

I. General information

NPI: 1073525879
Provider Name (Legal Business Name): CARL A WHITE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 06/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 N HOSPITAL DRIVE SUITE 530
WEST COLUMBIA SC
29169-4894
US

IV. Provider business mailing address

146 N HOSPITAL DRIVE SUITE 530
WEST COLUMBIA SC
29169-4894
US

V. Phone/Fax

Practice location:
  • Phone: 803-796-7270
  • Fax: 803-796-0106
Mailing address:
  • Phone: 803-796-7270
  • Fax: 803-796-0106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5568
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: