Provider Demographics
NPI:1225355993
Name:WHITE, PAUL KING (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KING
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:165 N PARK TRL STE 100
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6509
Mailing Address - Country:US
Mailing Address - Phone:770-506-1800
Mailing Address - Fax:770-389-4461
Practice Address - Street 1:165 N PARK TRL STE 100
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6509
Practice Address - Country:US
Practice Address - Phone:770-506-1800
Practice Address - Fax:770-389-4461
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0666722081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003149249AMedicaid
GA202I724400Medicare PIN