Provider Demographics
NPI:1821049347
Name:WHITE, JAMES WILLIAM JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WILLIAM
Last Name:WHITE
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:866 WOOTEN LAKE RD NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1339
Mailing Address - Country:US
Mailing Address - Phone:770-517-4819
Mailing Address - Fax:
Practice Address - Street 1:1362 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-5410
Practice Address - Country:US
Practice Address - Phone:706-276-4741
Practice Address - Fax:706-276-4645
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN124549367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA110205OtherMEDICARE PART A PROVIDER NUMBER
GA115683OtherGILMER NURSING HOME MEDICARE PROVIDER NUMBER
GAHOSP34OtherMEDICARE PART B PROVIDER NUMBER
GA190963580OtherGILMER NURSING HOME NPI NUMBER
GA11U205OtherMEDICARE SWING BED PROVIDER NUMBER
GA1275690703OtherNORTH GEORGIA MEDICAL CENTER SWING BED NPI
GA628576069BMedicaid
GA000002043AMedicaid
GA1952395097OtherNPI NORTH GEORGIA MEDICAL CENTER
GA1952395097OtherNPI NORTH GEORGIA MEDICAL CENTER
GA110205OtherMEDICARE PART A PROVIDER NUMBER