Provider Demographics
NPI:1295716579
Name:WHITE, MILTON E (MD)
Entity type:Individual
Prefix:
First Name:MILTON
Middle Name:E
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6128 PRESTLEY MILL RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-5621
Mailing Address - Country:US
Mailing Address - Phone:770-942-6903
Mailing Address - Fax:770-942-6908
Practice Address - Street 1:6128 PRESTLEY MILL RD
Practice Address - Street 2:SUITE G
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5621
Practice Address - Country:US
Practice Address - Phone:770-942-6903
Practice Address - Fax:770-942-6908
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA043304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000774386AMedicaid
GA11BDNKPMedicare ID - Type Unspecified
GA000774386AMedicaid