Provider Demographics
NPI:1083022644
Name:WHITE, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 RESOURCE LN
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-8361
Mailing Address - Country:US
Mailing Address - Phone:678-963-0694
Mailing Address - Fax:888-547-4008
Practice Address - Street 1:204 RESOURCE LN
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-8361
Practice Address - Country:US
Practice Address - Phone:678-963-0694
Practice Address - Fax:888-547-4008
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005951225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist