MEDICARE: DR. SANDRA LAFOREST WHITE 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	207RR0500X	Rheumatology Physician	020362	GA

General Provider Information

NPI Number	:	1972587020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA LAFOREST WHITE MD

Provider Business Mailing Address
First Line	:	4532 KINVARRA CIR SW
Second Line	:
City	:	MABLETON
State	:	GA
Zip	:	30126-1493
Country	:	US
Telephone Number	:	404-304-8218
Fax Number	:

Provider Business Practice Location Address
First Line	:	2451 CUMBERLAND PKWY SE
Second Line	:	SUITE 3311
City	:	ATLANTA
State	:	GA
Zip	:	30339-6136
Country	:	US
Telephone Number	:	404-304-9929
Fax Number	:

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

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	07/08/2007

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