Provider Demographics
NPI:1245478569
Name:WHITE, ANDREA TERESE (RN)
Entity type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:TERESE
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:4805 CHERRING DRIVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338
Mailing Address - Country:US
Mailing Address - Phone:770-458-7582
Mailing Address - Fax:770-544-2221
Practice Address - Street 1:5780 PEACHTREE DUNWOODY ROAD
Practice Address - Street 2:SUITE 195
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:770-544-2226
Practice Address - Fax:770-544-2221
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN061046261QA1903X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No282N00000XHospitalsGeneral Acute Care Hospital