Healthcare Provider Details

I. General information

NPI: 1073645313
Provider Name (Legal Business Name): JAMES BRIAN WHITE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 S ILLINOIS AVE
OAK RIDGE TN
37830-7550
US

IV. Provider business mailing address

PO BOX 32709
KNOXVILLE TN
37930-2709
US

V. Phone/Fax

Practice location:
  • Phone: 865-482-7730
  • Fax: 865-481-0531
Mailing address:
  • Phone: 865-558-6484
  • Fax: 865-584-4037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number7780
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: