MEDICARE: SAMANTHA WHITE BCBA

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1114410578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA WHITE BCBA

Provider Business Mailing Address
First Line	:	1410 DONELSON PIKE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37217-2933
Country	:	US
Telephone Number	:	615-913-8757
Fax Number	:	615-913-8784

Provider Business Practice Location Address
First Line	:	1410 DONELSON PIKE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37217-2933
Country	:	US
Telephone Number	:	615-913-8757
Fax Number	:	615-913-8784

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

Provider Enumeration Date	:	06/11/2018
Last Update Date	:	06/11/2018

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