MEDICARE: JESSICA GOGGINS WHITE PNP

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	363LP0200X	Pediatric Nurse Practitioner	RN180599	GA

General Provider Information

NPI Number	:	1548913205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA GOGGINS WHITE PNP

Provider Business Mailing Address
First Line	:	104 BENT OAK CIR
Second Line	:
City	:	THOMASVILLE
State	:	GA
Zip	:	31757-9507
Country	:	US
Telephone Number	:	229-221-1351
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 BENT OAK CIR
Second Line	:
City	:	THOMASVILLE
State	:	GA
Zip	:	31757-9507
Country	:	US
Telephone Number	:	229-221-1351
Fax Number	:

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

Provider Enumeration Date	:	02/01/2022
Last Update Date	:	02/01/2022

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