Provider Demographics
NPI:1598048746
Name:WHITE, TERRY S
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:S
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3980 VENTURE DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5077
Mailing Address - Country:US
Mailing Address - Phone:770-622-2317
Mailing Address - Fax:770-622-2326
Practice Address - Street 1:3980 VENTURE DR
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5077
Practice Address - Country:US
Practice Address - Phone:770-622-2317
Practice Address - Fax:770-622-2326
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20363183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist