Provider Demographics
NPI:1962916684
Name:WHITE, CORNELIUS L SR
Entity type:Individual
Prefix:MR
First Name:CORNELIUS
Middle Name:L
Last Name:WHITE
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2125
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29151-2125
Mailing Address - Country:US
Mailing Address - Phone:843-607-9258
Mailing Address - Fax:
Practice Address - Street 1:956 SHADOW TRL
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2352
Practice Address - Country:US
Practice Address - Phone:843-530-1870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care