Provider Demographics
NPI:1083854426
Name:WHITE, JOHN NOLAND JR (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:NOLAND
Last Name:WHITE
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BUTLER RD SE
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-9221
Mailing Address - Country:US
Mailing Address - Phone:478-251-0142
Mailing Address - Fax:478-454-1069
Practice Address - Street 1:700 W THOMAS ST
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2672
Practice Address - Country:US
Practice Address - Phone:478-251-0142
Practice Address - Fax:478-968-2900
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002787103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPSY002787OtherLICENSE