=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447508643
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. VICTORIA WARNER-WHITE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2012
-----------------------------------------------------
Last Update Date | 08/17/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2040 DAN PROCTOR DR STE 230
-----------------------------------------------------
City | SAINT MARYS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31558-3801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-576-6464
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2040 DAN PROCTOR DR STE 230
-----------------------------------------------------
City | SAINT MARYS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31558-3801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-576-6464
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LPN
-----------------------------------------------------
Name | MRS. RAYALTOR E FULTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 912-576-6464
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 039504
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------