Provider Demographics
NPI:1437670486
Name:WHITE, JORDAN GARRETT
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:GARRETT
Last Name:WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 KRISTEN CT
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70128-1170
Mailing Address - Country:US
Mailing Address - Phone:504-245-7525
Mailing Address - Fax:
Practice Address - Street 1:1830 SAINT BERNARD AVE STE B
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70116-1329
Practice Address - Country:US
Practice Address - Phone:504-603-2389
Practice Address - Fax:504-609-3366
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program