Provider Demographics
NPI:1760436513
Name:WHITE, DAVID ANTHONY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ANTHONY
Last Name:WHITE
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:678-957-3047
Practice Address - Street 1:750 TOWNPARK LN NW
Practice Address - Street 2:KAISER PERMANENTE TOWN PARK MEDICAL CENTER
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5579
Practice Address - Country:US
Practice Address - Phone:678-957-3040
Practice Address - Fax:678-957-3047
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2022-01-10
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Provider Licenses
StateLicense IDTaxonomies
FLPA9103659363A00000X
GA005699363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA148821379AMedicaid
FLU7391ZMedicare PIN
GA148821379AMedicaid