Provider Demographics
NPI:1720551260
Name:WHITE, HENRY ELLIOTT III (PA-C)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:ELLIOTT
Last Name:WHITE
Suffix:III
Gender:M
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 1:820 SUMNER DR APT 1
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5542
Mailing Address - Country:US
Mailing Address - Phone:910-578-9252
Mailing Address - Fax:
Practice Address - Street 1:8590 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-1940
Practice Address - Country:US
Practice Address - Phone:910-751-3181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-11226363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant