Provider Demographics
NPI:1851368377
Name:WHITE, GREGORY G (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:G
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GREGORY
Other - Middle Name:GEORGE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:600 PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7327
Mailing Address - Country:US
Mailing Address - Phone:386-424-3845
Mailing Address - Fax:386-424-3847
Practice Address - Street 1:600 PALMETTO ST
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7327
Practice Address - Country:US
Practice Address - Phone:386-424-3845
Practice Address - Fax:386-424-3847
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2023-03-07
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-08-08
Provider Licenses
StateLicense IDTaxonomies
TN26436174400000X
GA064093174400000X
FLME55812174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3090886Medicaid
TN3090882Medicaid
GA385639443AMedicaid
GA385639443AMedicaid
3090885Medicare PIN
TN3090886Medicaid
3090886Medicare PIN