Provider Demographics
NPI:1841339512
Name:WHITE, JAMES O (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:O
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2705 HIGHWAY 51 S
Mailing Address - Street 2:DESOTO COUNTY HEALTH DEPT.
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-2634
Mailing Address - Country:US
Mailing Address - Phone:662-429-9814
Mailing Address - Fax:662-429-2169
Practice Address - Street 1:2705 HIGHWAY 51 S
Practice Address - Street 2:DESOTO COUNTY HEALTH DEPT.
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-2634
Practice Address - Country:US
Practice Address - Phone:662-429-9814
Practice Address - Fax:662-429-2169
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07071251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00123668Medicaid
MSE05459Medicare UPIN