MEDICARE: ANTHONY JERELL WHITE

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1861320699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY JERELL WHITE

Provider Business Mailing Address
First Line	:	1987 GENERAL NEYLAND DR
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37042-9574
Country	:	US
Telephone Number	:	931-217-3499
Fax Number	:

Provider Business Practice Location Address
First Line	:	1987 GENERAL NEYLAND DR
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37042-9574
Country	:	US
Telephone Number	:	931-217-3499
Fax Number	:

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

Provider Enumeration Date	:	05/12/2026
Last Update Date	:	05/12/2026

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Directions to “ ANTHONY JERELL WHITE ” Practice Location

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