Provider Demographics
NPI:1104005594
Name:WHITE'S PEDIATRICS
Entity type:Organization
Organization Name:WHITE'S PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARBOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-876-2179
Mailing Address - Street 1:1575 CHATTANOOGA AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2671
Mailing Address - Country:US
Mailing Address - Phone:706-876-2131
Mailing Address - Fax:
Practice Address - Street 1:1575 CHATTANOOGA AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2671
Practice Address - Country:US
Practice Address - Phone:706-876-2131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022667208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty