Provider Demographics
NPI:1699882068
Name:WHITE, THOMAS H (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:H
Last Name:WHITE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 EE BUTLER PKWY
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-4524
Mailing Address - Country:US
Mailing Address - Phone:770-534-9460
Mailing Address - Fax:770-534-9597
Practice Address - Street 1:451 EE BUTLER PKWY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-4524
Practice Address - Country:US
Practice Address - Phone:770-534-9460
Practice Address - Fax:770-534-9597
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1074103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBFVVMedicare ID - Type Unspecified
GAR74780Medicare UPIN