Provider Demographics
NPI:1972587020
Name:WHITE, SANDRA LAFOREST (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LAFOREST
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4532 KINVARRA CIR SW
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-1493
Mailing Address - Country:US
Mailing Address - Phone:404-304-8218
Mailing Address - Fax:
Practice Address - Street 1:2451 CUMBERLAND PKWY SE
Practice Address - Street 2:SUITE 3311
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-6136
Practice Address - Country:US
Practice Address - Phone:404-304-9929
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA020362207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD41372Medicare UPIN