Provider Demographics
NPI:1972664720
Name:WHITE, JACKSON B (MD)
Entity Type:Individual
Prefix:
First Name:JACKSON
Middle Name:B
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 STEWARTS FERRY PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3325
Mailing Address - Country:US
Mailing Address - Phone:615-902-7459
Mailing Address - Fax:615-902-7706
Practice Address - Street 1:221 STEWARTS FERRY PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3325
Practice Address - Country:US
Practice Address - Phone:615-902-7459
Practice Address - Fax:615-902-7706
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000145192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3020574Medicare ID - Type Unspecified
TNA98419Medicare UPIN