MEDICARE: STEPHEN FRANKLIN WHITE JR. MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207Y00000X	Otolaryngology Physician	103714	GA

General Provider Information

NPI Number	:	1710440318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN FRANKLIN WHITE JR. MD

Provider Business Mailing Address
First Line	:	4150 DEPUTY BILL CANTRELL MEMORIAL ROAD
Second Line	:	SUITE 260
City	:	CUMMING
State	:	GA
Zip	:	30040-3021
Country	:	US
Telephone Number	:	770-292-3045
Fax Number	:	770-292-3046

Provider Business Practice Location Address
First Line	:	4150 DEPUTY BILL CANTRELL MEMORIAL ROAD
Second Line	:	SUITE 260
City	:	CUMMING
State	:	GA
Zip	:	30040-3021
Country	:	US
Telephone Number	:	770-292-3045
Fax Number	:	770-292-3046

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

Provider Enumeration Date	:	04/10/2019
Last Update Date	:	08/26/2025

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