MEDICARE: DR. CAARNE L WHITE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP1600X	Pastoral Counselor	2208098	GA

General Provider Information

NPI Number	:	1083382527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAARNE L WHITE

Provider Business Mailing Address
First Line	:	1509 CULPEPPER LN
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-6897
Country	:	US
Telephone Number	:	678-855-5468
Fax Number	:

Provider Business Practice Location Address
First Line	:	804 PAVILION CT
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-6666
Country	:	US
Telephone Number	:	678-814-4060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2021
Last Update Date	:	08/31/2021

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