Provider Demographics
NPI:1619553526
Name:WHITE, GRANT HARRISON (DO)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:HARRISON
Last Name:WHITE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 HOSPITAL DRIVE
Mailing Address - Street 2:BUILDING A, SUITE 430
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-8017
Mailing Address - Country:US
Mailing Address - Phone:478-751-0367
Mailing Address - Fax:
Practice Address - Street 1:380 HOSPITAL DRIVE
Practice Address - Street 2:BUILDING A, SUITE 430
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-8017
Practice Address - Country:US
Practice Address - Phone:478-751-0367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program