Provider Demographics
NPI:1114946290
Name:STEPHEN A. WHITE, M.D., P.C.
Entity Type:Organization
Organization Name:STEPHEN A. WHITE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-552-3031
Mailing Address - Street 1:2289 B RUDOLPHTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4539
Mailing Address - Country:US
Mailing Address - Phone:931-552-3031
Mailing Address - Fax:931-552-9820
Practice Address - Street 1:2289 B RUDOLPHTOWN ROAD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4539
Practice Address - Country:US
Practice Address - Phone:931-552-3031
Practice Address - Fax:931-552-9820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD14198207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3153602OtherBLUE CROSS
TN3721373Medicaid
TN3721373Medicare ID - Type UnspecifiedMEDICARE
TN3153602OtherBLUE CROSS