Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 029261 | GA |
NPI | 1902887714 |
---|---|
Provider Name | Dr. Benjamin White |
First Address | Atlanta, GA 30342-1731 |
Second Address | Atlanta, GA 30342-1731 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 01/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000338643J | (05) | GA |
AW9186380 | DEA (01) | GA |
D41813 | (02) | GA |