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General NPI Number Information
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NPI Number | 1003815358
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Entity Type | Individual
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Provider Name | MICHAEL JAY WHITE MD
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Gender | Male
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 1830 PONDFIELD RD SUITE A
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City | NEWBERRY
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State | SC
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Zip | 29108-9522
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Country | US
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Telephone | 803-405-7230
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 749306
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City | ATLANTA
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State | GA
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Zip | 30374-9306
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Country | US
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Telephone | 803-796-4251
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Fax | 803-796-4449
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number | 73670
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME108837
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 23345
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number | 073670
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License Number State | GA
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