Provider Demographics
NPI:1174818959
Name:WHITE, JANET WOOD
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:WOOD
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 1:375 18TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30363-1190
Mailing Address - Country:US
Mailing Address - Phone:678-954-4266
Mailing Address - Fax:678-954-4276
Practice Address - Street 1:375 18TH ST NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30363-1190
Practice Address - Country:US
Practice Address - Phone:678-954-4266
Practice Address - Fax:678-954-4276
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024581183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist