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General NPI Number Information
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NPI Number | 1174376115
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Entity Type | Organization
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Legal Business Name | DR PAUL WHITE LLC
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Dates
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Enumeration Date | 04/09/2024
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Last Update Date | 04/09/2024
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Provider Practice Location Address
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Address Line | 135 WILLOW LN
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City | MCDONOUGH
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State | GA
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Zip | 30253-6574
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Country | US
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Telephone | 678-432-3093
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Fax |
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Provider Business Mailing Address
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Address Line | 1363 JEFFERSON AVE
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City | EAST POINT
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State | GA
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Zip | 30344-2661
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL WHITE
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Credential |
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Telephone | 770-558-0280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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