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General NPI Number Information
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NPI Number | 1497016034
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Entity Type | Individual
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Provider Name | STEPHEN DANIEL WHITE M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/30/2012
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Last Update Date | 07/27/2020
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Provider Practice Location Address
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Address Line | 1305 JENNINGS MILL RD STE 110
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City | WATKINSVILLE
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State | GA
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Zip | 30677-7241
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Country | US
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Telephone | 706-613-5880
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Fax |
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Provider Business Mailing Address
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Address Line | 3650 J DEWEY GRAY CIR
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City | AUGUSTA
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State | GA
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Zip | 30909-1867
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Country | US
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Telephone | 706-863-9797
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Fax | 706-860-7686
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 2017-00691
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 79912
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License Number State | GA
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