Provider Demographics
NPI:1003937400
Name:WHITE, ANTHONY RICARDO (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:RICARDO
Last Name:WHITE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 OLD 41 HWY NW STE 370
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4429
Mailing Address - Country:US
Mailing Address - Phone:770-575-3103
Mailing Address - Fax:
Practice Address - Street 1:1815 OLD 41 HWY NW STE 370
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-4429
Practice Address - Country:US
Practice Address - Phone:770-575-3103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007626111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA9344506OtherPHCS
GA665387OtherUNITED HEALTHCARE
GA35ZHTQMedicare ID - Type Unspecified