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General NPI Number Information
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NPI Number | 1558620278
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Entity Type | Individual
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Provider Name | KEITH ANTHONY WHITE M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/15/2012
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 1 MEDICAL PARK BLVD FL 5
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City | BRISTOL
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State | TN
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Zip | 37620-7430
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Country | US
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Telephone | 423-844-1121
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 W OAKLAND AVE STE 310
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2192
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Country | US
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Telephone | 423-302-6565
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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 | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number | 0101258192
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number | 54778
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 54778
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 010125819
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License Number State | VA
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