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General NPI Number Information
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NPI Number | 1710073887
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Entity Type | Organization
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Legal Business Name | NORTH VALLEY MEDICAL CORPORATION
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 473 SOUTH ST
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City | REDDING
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State | CA
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Zip | 96001-2105
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Country | US
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Telephone | 530-242-1415
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Fax |
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Provider Business Mailing Address
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Address Line | 2205 HILLTOP DR # 1
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City | REDDING
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State | CA
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Zip | 96002-0511
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Country | US
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Telephone | 530-242-1415
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES GREGORY WHITE
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Credential | M.D.
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Telephone | 530-242-1415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | A30743
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License Number State | CA
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