Provider Demographics
NPI:1851366520
Name:WHITE, TIMOTHY EDWARD II (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:EDWARD
Last Name:WHITE
Suffix:II
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-5017
Mailing Address - Country:US
Mailing Address - Phone:910-671-9790
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF NORTH CAROLINA AT PEMBROKE
Practice Address - Street 2:HPER DEPT.
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-1510
Practice Address - Country:US
Practice Address - Phone:910-522-5727
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1145246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other