Provider Demographics
NPI:1922695048
Name:WHITE, HAMPTON III
Entity Type:Individual
Prefix:
First Name:HAMPTON
Middle Name:
Last Name:WHITE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7018 BRIDGESIDE PL
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-8229
Mailing Address - Country:US
Mailing Address - Phone:804-539-3836
Mailing Address - Fax:804-454-1768
Practice Address - Street 1:7018 BRIDGESIDE PL
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-8229
Practice Address - Country:US
Practice Address - Phone:804-539-3836
Practice Address - Fax:804-454-1768
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA199343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)