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General NPI Number Information
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NPI Number | 1215001144
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Entity Type | Individual
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Provider Name | HORACE ROGER WHITE M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 49 S MARIETTA PKWY SW #C
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City | MARIETTA
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State | GA
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Zip | 30064-3288
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Country | US
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Telephone | 770-424-0647
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Fax | 770-590-5990
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Provider Business Mailing Address
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Address Line | 1660 CAVAN DR SW
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City | MARIETTA
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State | GA
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Zip | 30064-2942
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Country | US
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Telephone | 770-424-1782
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 16447
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License Number State | GA
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