Provider Demographics
NPI:1235120262
Name:WHITE, CHARLES WESLEY SR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WESLEY
Last Name:WHITE
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-1422
Mailing Address - Country:US
Mailing Address - Phone:731-249-5804
Mailing Address - Fax:731-249-5807
Practice Address - Street 1:14 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351
Practice Address - Country:US
Practice Address - Phone:731-249-5804
Practice Address - Fax:731-249-5807
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4580207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3130409Medicaid
TN454070694OtherTAX ID
TN626001636OtherHEALTH PARTNERS
TNP00038794OtherRAILROAD MEDICARE
TN626001636OtherUSA MANAGED CARE
TNJT1011OtherCIGNA
TN152668OtherUNISON
TN4057252OtherBLUE CROSS BLUE SHIELD
TN626001636OtherUNITED HEALTHCARE
TN27392OtherTLC
TN432626025OtherTRICARE
TNQ020057Medicaid
TN3130409Medicaid
TN4057252OtherBLUE CROSS BLUE SHIELD
TN3041966Medicare PIN