Provider Demographics
NPI:1699965814
Name:ANNE WHITE MD PC
Entity type:Organization
Organization Name:ANNE WHITE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:DENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:706-295-5150
Mailing Address - Street 1:909 N 5TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-2706
Mailing Address - Country:US
Mailing Address - Phone:706-295-5150
Mailing Address - Fax:706-295-4865
Practice Address - Street 1:909 N 5TH AVE NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2706
Practice Address - Country:US
Practice Address - Phone:706-295-5150
Practice Address - Fax:706-295-4865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN093196363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADG2418OtherRAILROAD MEDICARE
GA00403631EMedicaid
GAGRP8090Medicare PIN
GADG2418OtherRAILROAD MEDICARE