MEDICARE: JONATHAN STEPHEN WHITE PA-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	363A00000X	Physician Assistant	PA713	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01328036	OTHER	TN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922169572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN STEPHEN WHITE PA-C

Provider Business Mailing Address
First Line	:	PO BOX 681789
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37068-1789
Country	:	US
Telephone Number	:	931-455-0120
Fax Number	:

Provider Business Practice Location Address
First Line	:	144 JACK FARRAR LN
Second Line	:
City	:	TULLAHOMA
State	:	TN
Zip	:	37388-2398
Country	:	US
Telephone Number	:	931-455-0120
Fax Number	:

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

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	08/13/2015

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