Provider Demographics
NPI:1568438612
Name:WHITE, NETTIE M (MD)
Entity Type:Individual
Prefix:DR
First Name:NETTIE
Middle Name:M
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:NC
Mailing Address - Zip Code:28753-0069
Mailing Address - Country:US
Mailing Address - Phone:828-649-9566
Mailing Address - Fax:828-649-3786
Practice Address - Street 1:119 MOUNTAIN VIEW RD
Practice Address - Street 2:
Practice Address - City:MARS HILL
Practice Address - State:NC
Practice Address - Zip Code:28754-9500
Practice Address - Country:US
Practice Address - Phone:828-689-3507
Practice Address - Fax:828-689-3505
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27538207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7987065Medicaid
NCD27156Medicare UPIN
NC211484Medicare PIN