Provider Demographics
NPI:1962415117
Name:JOHN W. WHITE, JR., MD, PA
Entity type:Organization
Organization Name:JOHN W. WHITE, JR., MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:CRANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-566-5593
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:1423 PALMETTO ROAD
Mailing Address - City:VERONA
Mailing Address - State:MS
Mailing Address - Zip Code:38879-0429
Mailing Address - Country:US
Mailing Address - Phone:662-566-5593
Mailing Address - Fax:662-566-4419
Practice Address - Street 1:1423 PALMETTO ROAD
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:MS
Practice Address - Zip Code:38879-0429
Practice Address - Country:US
Practice Address - Phone:662-566-5593
Practice Address - Fax:662-566-4419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08873263Medicaid
MS253857Medicare PIN
MSC02697Medicare PIN