Provider Demographics
NPI:1922621085
Name:WHITE, JULIAN (BS)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8529 GROVER PL
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2707
Mailing Address - Country:US
Mailing Address - Phone:318-344-3549
Mailing Address - Fax:
Practice Address - Street 1:8529 GROVER PL
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2707
Practice Address - Country:US
Practice Address - Phone:318-344-3549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-24
Last Update Date:2020-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator