Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 066672 | GA |
NPI | 1225355993 |
---|---|
Provider Name | Dr. Paul King White |
First Address | Stockbridge, GA 30281-6509 |
Second Address | Stockbridge, GA 30281-6509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2010 |
Last Update Date | 27/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003149249A | (05) | GA |