Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | PTA1061 | MS |
NPI | 1033409602 |
---|---|
Provider Name | Teresa M White |
First Address | Columbus, MS 39705-5305 |
Second Address | Ridgeland, MS 39157-5120 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2011 |
Last Update Date | 15/04/2011 |