MEDICARE: DR. KELLY W WHITE M.D.

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	69114	TN

General Provider Information

NPI Number	:	1821808387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY W WHITE M.D.

Provider Business Mailing Address
First Line	:	2714 UNION AVENUE EXT STE 150
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38112-4431
Country	:	US
Telephone Number	:	901-617-1359
Fax Number	:

Provider Business Practice Location Address
First Line	:	2714 UNION AVENUE EXT STE 150
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38112-4431
Country	:	US
Telephone Number	:	901-725-0872
Fax Number	:

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

Provider Enumeration Date	:	01/08/2025
Last Update Date	:	02/11/2026

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