Provider Demographics
NPI:1467045963
Name:WHITE, CAROL FELICIA (CNA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:FELICIA
Last Name:WHITE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1545
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30475-1545
Mailing Address - Country:US
Mailing Address - Phone:912-403-9750
Mailing Address - Fax:
Practice Address - Street 1:185 SCARLETT OHARA DRIVE
Practice Address - Street 2:
Practice Address - City:AILEY
Practice Address - State:GA
Practice Address - Zip Code:30410
Practice Address - Country:US
Practice Address - Phone:912-403-9750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0000041443374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide