Provider Demographics
NPI:1578104170
Name:WHITE, MARY KATHERINE THRASH (NP)
Entity Type:Individual
Prefix:
First Name:MARY KATHERINE
Middle Name:THRASH
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 1:9 COLLIER LN NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-3901
Mailing Address - Country:US
Mailing Address - Phone:404-355-1074
Mailing Address - Fax:
Practice Address - Street 1:111 MOUNTAIN BROOK DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-9045
Practice Address - Country:US
Practice Address - Phone:678-880-9654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA146770208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics