Provider Demographics
NPI:1700973765
Name:WHITE, CORY RAFE (MD)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:RAFE
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 743294
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3294
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:2 INNOVATION DRIVE, STE 300 B
Practice Address - Street 2:BON SECOURS ENDOCRINOLOGY
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5261
Practice Address - Country:US
Practice Address - Phone:864-400-3680
Practice Address - Fax:877-249-9506
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC24858207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC576007863063OtherBCBS OF SC
SCP00725463OtherRR MEDICARE
SC248583Medicaid
SCAA29603640Medicare PIN
SC248583Medicaid