MEDICARE: MADDISON JOSEPHINE DAVIS WHITE FNP-C

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	363LF0000X	Family Nurse Practitioner	38492	TN

General Provider Information

NPI Number	:	1487457974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADDISON JOSEPHINE DAVIS WHITE FNP-C

Provider Business Mailing Address
First Line	:	297 CREEKWOOD COVE LN APT 8A
Second Line	:
City	:	LENOIR CITY
State	:	TN
Zip	:	37772-6392
Country	:	US
Telephone Number	:	865-518-3953
Fax Number	:

Provider Business Practice Location Address
First Line	:	16850 STATE HIGHWAY 58 S
Second Line	:
City	:	DECATUR
State	:	TN
Zip	:	37322-5259
Country	:	US
Telephone Number	:	423-334-3200
Fax Number	:	423-454-0125

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

Provider Enumeration Date	:	03/31/2025
Last Update Date	:	03/31/2025

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