Provider Demographics
NPI:1801853783
Name:WHITE, MARSHALL A (MD)
Entity type:Individual
Prefix:
First Name:MARSHALL
Middle Name:A
Last Name:WHITE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 BEN SAWYER BLVD STE 8
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4593
Mailing Address - Country:US
Mailing Address - Phone:843-696-3705
Mailing Address - Fax:843-388-5839
Practice Address - Street 1:1470 BEN SAWYER BLVD STE 8
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4593
Practice Address - Country:US
Practice Address - Phone:843-696-3705
Practice Address - Fax:843-388-5839
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13431101Y00000X, 101YM0800X, 2084B0040X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC134312Medicaid
SCGP3879Medicaid
SCE29968Medicare UPIN