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1063521292 NPI number — DEANNA R WHITE MD

NPI Number: 1063521292
Health Care Provider/Practitioner: DEANNA R WHITE MD

Information about “1063521292” NPI (DEANNA R WHITE MD) exists in 1063521292 in HTML format HTML  |  1063521292 in plain Text format TXT  |  1063521292 in PDF (Portable Document Format) PDF  |  1063521292 in an XML format XML  formats.

NPI Number : 1063521292 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1063521292",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WHITE",
    "FirstName": "DEANNA",
    "MiddleName": "R",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3555 HARDEN STREET EXT STE 300",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COLUMBIA",
    "MailingAddressStateName": "SC",
    "MailingAddressPostalCode": "29203-6894",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "803-545-5016",
    "MailingAddressFaxNumber": "803-255-3451",
    "FirstLinePracticeLocationAddress": "14 RICHLAND MEDICAL PARK DR STE 320",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COLUMBIA",
    "PracticeLocationAddressStateName": "SC",
    "PracticeLocationAddressPostalCode": "29203-6896",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "803-434-6771",
    "PracticeLocationAddressFaxNumber": "803-434-3855",
    "EnumerationDate": "08/30/2006",
    "LastUpdateDate": "12/14/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": "19071",
          "LicenseNumberStateCode": "MS",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": "40367",
          "LicenseNumberStateCode": "SC",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": "36316",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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