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General NPI Number Information
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NPI Number | 1275816811
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Entity Type | Individual
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Provider Name | DR. JESSICA WHITE
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Gender | Female
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Dates
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Enumeration Date | 09/20/2011
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Last Update Date | 09/20/2011
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Provider Practice Location Address
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Address Line | 2670 COBB PKWY SE
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City | SMYRNA
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State | GA
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Zip | 30080-3014
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Country | US
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Telephone | 770-955-7453
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Fax |
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Provider Business Mailing Address
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Address Line | 5733 VININGS RETREAT WAY SW
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City | MABLETON
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State | GA
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Zip | 30126-2575
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Country | US
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Telephone | 205-238-4519
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH025574
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License Number State | GA
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