Provider Demographics
NPI:1568906717
Name:WHITE, JOHN ALEXANDER JR (LMBT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ALEXANDER
Last Name:WHITE
Suffix:JR
Gender:M
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 BLUE RIDGE RD STE G160
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6366
Mailing Address - Country:US
Mailing Address - Phone:919-218-6792
Mailing Address - Fax:919-787-9052
Practice Address - Street 1:2501 BLUE RIDGE RD STE G160
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6366
Practice Address - Country:US
Practice Address - Phone:919-218-6792
Practice Address - Fax:919-787-9052
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5188173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist