Provider Demographics
NPI:1477754992
Name:WHITE, LYDIA A (MD)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:A
Last Name:WHITE
Suffix:
Gender:F
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:PO BOX 306556
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6556
Mailing Address - Country:US
Mailing Address - Phone:865-243-8153
Mailing Address - Fax:
Practice Address - Street 1:1800 MEDICAL CENTER PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2567
Practice Address - Country:US
Practice Address - Phone:615-896-6800
Practice Address - Fax:615-895-8890
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48759207X00000X, 207XX0005X
OH57012224207X00000X
FLME109283207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003715400Medicaid
AL129763Medicaid
AL129762Medicaid
FL14E79OtherBLUE CROSS BLUE SHIELD
AL593-07438OtherBLUE CROSS BLUE SHIELD
AL593-07437OtherBLUE CROSS BLUE SHIELD
AL129763Medicaid