Provider Demographics
NPI:1811449549
Name:WHITE, FRANK THOMAS JR (MED-CCC)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:THOMAS
Last Name:WHITE
Suffix:JR
Gender:M
Credentials:MED-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 SPRING CREEK LN
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-3818
Mailing Address - Country:US
Mailing Address - Phone:470-331-3039
Mailing Address - Fax:
Practice Address - Street 1:108 FORREST AVE
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3614
Practice Address - Country:US
Practice Address - Phone:770-926-2884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009405235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist