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General NPI Number Information
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NPI Number | 1760276216
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Entity Type | Individual
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Provider Name | JEREMIAH WHITE SR.
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Gender | Male
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Dates
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Enumeration Date | 04/08/2025
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 4615 DUNN AVE
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City | MEMPHIS
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State | TN
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Zip | 38117-6512
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Country | US
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Telephone | 573-481-5473
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Fax | 573-481-5473
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Provider Business Mailing Address
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Address Line | 3340 GREENWAY DR
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City | HORN LAKE
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State | MS
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Zip | 38637-2642
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Country | US
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Telephone | 573-481-5473
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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