Provider Demographics
NPI:1255684700
Name:WHITE, CARLENE KAMILAH (RN)
Entity Type:Individual
Prefix:MRS
First Name:CARLENE
Middle Name:KAMILAH
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 HOLLINDALE LN NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7317
Mailing Address - Country:US
Mailing Address - Phone:678-849-0329
Mailing Address - Fax:
Practice Address - Street 1:125 TOWNPARK DR NW STE 300
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5812
Practice Address - Country:US
Practice Address - Phone:662-753-9678
Practice Address - Fax:678-348-7317
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN161620163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management