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General NPI Number Information
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NPI Number | 1063267128
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Entity Type | Organization
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Legal Business Name | WHITE-WILSON MEDICAL CENTER, P.A.
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 1045 US HIGHWAY 331 S
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City | DEFUNIAK SPRINGS
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State | FL
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Zip | 32435-3379
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Country | US
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Telephone | 850-892-3366
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Fax | 833-451-2226
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Provider Business Mailing Address
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Address Line | 1005 MAR WALT DR
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6707
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Country | US
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Telephone | 850-863-8299
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Fax | 850-863-4152
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Authorized Official
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Title or Position | CEO
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Name | KENNETH PERSAUD
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Credential |
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Telephone | 850-863-8150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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