Provider Demographics
NPI:1164604260
Name:WHITE, CHRISTOPHER EDWARDS (LMT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:EDWARDS
Last Name:WHITE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5912
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-5912
Mailing Address - Country:US
Mailing Address - Phone:912-322-4371
Mailing Address - Fax:
Practice Address - Street 1:103 N JULIA ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-9133
Practice Address - Country:US
Practice Address - Phone:912-322-4371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT430225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist