Provider Demographics
NPI:1366423584
Name:WHITE, JENNIFER S (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:S
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 MEDICAL PARK DR E
Mailing Address - Street 2:SUITE 457
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3400
Mailing Address - Country:US
Mailing Address - Phone:205-838-3800
Mailing Address - Fax:205-838-3206
Practice Address - Street 1:48 MEDICAL PARK DR E
Practice Address - Street 2:SUITE 457
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3400
Practice Address - Country:US
Practice Address - Phone:205-838-3800
Practice Address - Fax:205-838-3206
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22040207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051511989Medicaid
AL051511989Medicaid
AL051511989Medicare ID - Type UnspecifiedMEDICARE #