Provider Demographics
NPI:1679335822
Name:WHITE, FABIAN LLOYD JR
Entity Type:Individual
Prefix:MR
First Name:FABIAN
Middle Name:LLOYD
Last Name:WHITE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9168 HIGHWAY 84
Mailing Address - Street 2:
Mailing Address - City:FERRIDAY
Mailing Address - State:LA
Mailing Address - Zip Code:71334-4604
Mailing Address - Country:US
Mailing Address - Phone:601-493-4710
Mailing Address - Fax:
Practice Address - Street 1:9168 HIGHWAY 84
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334-4604
Practice Address - Country:US
Practice Address - Phone:601-493-4710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health