Provider Demographics
NPI:1588277719
Name:WHITE, IASIA N
Entity type:Individual
Prefix:MRS
First Name:IASIA
Middle Name:N
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5833 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-4513
Mailing Address - Country:US
Mailing Address - Phone:404-285-9719
Mailing Address - Fax:404-393-1325
Practice Address - Street 1:5833 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30168-4513
Practice Address - Country:US
Practice Address - Phone:404-285-9719
Practice Address - Fax:404-393-1325
Is Sole Proprietor?:No
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide