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General NPI Number Information
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NPI Number | 1821049347
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Entity Type | Individual
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Provider Name | JAMES WILLIAM WHITE JR. CRNA
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Gender | Male
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 05/10/2022
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Provider Practice Location Address
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Address Line | 1362 S MAIN ST
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City | ELLIJAY
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State | GA
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Zip | 30540-5410
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Country | US
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Telephone | 706-276-4741
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Fax | 706-276-4645
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Provider Business Mailing Address
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Address Line | 866 WOOTEN LAKE RD NW
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City | KENNESAW
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State | GA
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Zip | 30144-1339
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Country | US
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Telephone | 770-517-4819
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN124549
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License Number State | GA
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