Provider Demographics
NPI:1881854743
Name:VICTORIA Y. WARNER-WHITE M.D.
Entity Type:Organization
Organization Name:VICTORIA Y. WARNER-WHITE M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:YALONDA
Authorized Official - Last Name:WARNER-WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-576-6464
Mailing Address - Street 1:2040 DAN PROCTOR DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-3811
Mailing Address - Country:US
Mailing Address - Phone:912-576-6464
Mailing Address - Fax:912-576-6460
Practice Address - Street 1:2040 DAN PROCTOR DR
Practice Address - Street 2:SUITE 230
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3811
Practice Address - Country:US
Practice Address - Phone:912-576-6464
Practice Address - Fax:912-576-6460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039504305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00636633BMedicaid
GA261653847OtherTRICARE
GA015004OtherBLUE CROSS BLUE SHIELD