Provider Demographics
NPI:1023672672
Name:WHITE, STEPHANIE SMITH (LPN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SMITH
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-4524
Mailing Address - Country:US
Mailing Address - Phone:770-358-5252
Mailing Address - Fax:706-646-6039
Practice Address - Street 1:713 ANDREWS DR
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-4524
Practice Address - Country:US
Practice Address - Phone:770-358-5252
Practice Address - Fax:706-646-6039
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN087917164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse