Provider Demographics
NPI:1497134308
Name:WHITE, EVA (NP)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 MIDDLEBROOKS RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:GA
Mailing Address - Zip Code:30293-2619
Mailing Address - Country:US
Mailing Address - Phone:706-553-9547
Mailing Address - Fax:770-567-1468
Practice Address - Street 1:1070 COUNTY FARM RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:GA
Practice Address - Zip Code:30295
Practice Address - Country:US
Practice Address - Phone:770-567-2145
Practice Address - Fax:770-567-1468
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN121324363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily