Provider Demographics
NPI:1073985800
Name:WHITE OAK MEDICAL PLLC
Entity Type:Organization
Organization Name:WHITE OAK MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JOHNATHAN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:SAWYER
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:910-326-3742
Mailing Address - Street 1:205 WARD RD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SWANSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28584-8265
Mailing Address - Country:US
Mailing Address - Phone:910-326-3742
Mailing Address - Fax:
Practice Address - Street 1:205 WARD RD
Practice Address - Street 2:SUITE #2
Practice Address - City:SWANSBORO
Practice Address - State:NC
Practice Address - Zip Code:28584-8265
Practice Address - Country:US
Practice Address - Phone:910-326-3742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-20
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00402363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty