Provider Demographics
NPI:1952472201
Name:WHITE, GEORGE WILLIAM III
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:WILLIAM
Last Name:WHITE
Suffix:III
Gender:M
Credentials:
Other - Prefix:MRS
Other - First Name:CATHERINE
Other - Middle Name:LOUISE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:141 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:HUEYTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:35023-2408
Mailing Address - Country:US
Mailing Address - Phone:205-491-2109
Mailing Address - Fax:205-491-7772
Practice Address - Street 1:141 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-2408
Practice Address - Country:US
Practice Address - Phone:205-491-2109
Practice Address - Fax:205-491-7772
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL042358332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies