MEDICARE: SHEENA WHITE MS, MMSC-PA

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	2255A2300X	Athletic Trainer	ATH.200124	LA
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1134433691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEENA WHITE MS, MMSC-PA

Provider Business Mailing Address
First Line	:	490 BILL KENNEDY WAY SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-6835
Country	:	US
Telephone Number	:	404-446-4726
Fax Number	:

Provider Business Practice Location Address
First Line	:	490 BILL KENNEDY WAY SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-6835
Country	:	US
Telephone Number	:	404-446-4726
Fax Number	:

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

Provider Enumeration Date	:	07/27/2010
Last Update Date	:	01/03/2018

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