Provider Demographics
NPI:1396731675
Name:WHITE, JOAN W (MD)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:W
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:807 MEADOWLARK LN
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-2307
Mailing Address - Country:US
Mailing Address - Phone:615-859-6650
Mailing Address - Fax:615-851-1983
Practice Address - Street 1:807 MEADOWLARK LN
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2307
Practice Address - Country:US
Practice Address - Phone:615-859-6650
Practice Address - Fax:615-851-1983
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN19382208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
3036281OtherBCBS OF TN
TN3042537Medicare ID - Type Unspecified
3036281OtherBCBS OF TN