Provider Demographics
NPI:1629331707
Name:WHITE, BLAIR LEIGH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BLAIR
Middle Name:LEIGH
Last Name:WHITE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1061 DOWDY RD
Mailing Address - Street 2:SUITE 100 AND 101
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-5700
Mailing Address - Country:US
Mailing Address - Phone:706-621-7575
Mailing Address - Fax:706-621-7557
Practice Address - Street 1:1061 DOWDY RD
Practice Address - Street 2:SUITE 100 AND 101
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-5700
Practice Address - Country:US
Practice Address - Phone:706-621-7575
Practice Address - Fax:706-621-7557
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6428363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical