Provider Demographics
NPI:1508829417
Name:WHITE, ANN K (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:K
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 1:3400 OLD MILTON PKWY
Mailing Address - Street 2:BLDG C SUITE 465
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3707
Mailing Address - Country:US
Mailing Address - Phone:770-777-1100
Mailing Address - Fax:770-751-9089
Practice Address - Street 1:3400 OLD MILTON PKWY
Practice Address - Street 2:BLDG C SUITE 465
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3707
Practice Address - Country:US
Practice Address - Phone:770-777-1100
Practice Address - Fax:770-751-9089
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035352207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA04BDBJB OR 04BDBJB01Medicaid
GA04BDBJB OR 04BDBJB01Medicaid