Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHIR007626 | GA |
NPI | 1003937400 |
---|---|
Provider Name | Dr. Anthony Ricardo White |
First Address | Kennesaw, GA 30152-4429 |
Second Address | Kennesaw, GA 30152-4429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 26/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
665387 | UNITED HEALTHCARE (01) | GA |
9344506 | PHCS (01) | GA |