Provider Demographics
NPI:1750153003
Name:WHITE, JAMALA SARAN (CPT)
Entity type:Individual
Prefix:
First Name:JAMALA
Middle Name:SARAN
Last Name:WHITE
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 ROCK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6494
Mailing Address - Country:US
Mailing Address - Phone:843-496-4000
Mailing Address - Fax:
Practice Address - Street 1:1104 ROCK CREEK DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6494
Practice Address - Country:US
Practice Address - Phone:843-496-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCG6W7A4E5202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology