Provider Demographics
NPI:1992855407
Name:WHITE, BYRON EDWARD
Entity Type:Individual
Prefix:MR
First Name:BYRON
Middle Name:EDWARD
Last Name:WHITE
Suffix:
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 1:2801 LINCOYA DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-1821
Mailing Address - Country:US
Mailing Address - Phone:615-883-6579
Mailing Address - Fax:615-883-0065
Practice Address - Street 1:2801 LINCOYA DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-1821
Practice Address - Country:US
Practice Address - Phone:615-883-6579
Practice Address - Fax:615-883-0065
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDME 815174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454123Medicaid
TN1454123Medicaid