Provider Demographics
NPI:1912961764
Name:WHITE, SEAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:P
Last Name:WHITE
Suffix:
Gender:M
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:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2093
Mailing Address - Fax:423-390-3340
Practice Address - Street 1:105 W STONE DR STE 5D
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3365
Practice Address - Country:US
Practice Address - Phone:423-247-7500
Practice Address - Fax:423-390-4369
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD36075207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1912961764Medicaid
TN3871718Medicaid
TN3871717Medicaid
TN3871717Medicaid
VA1912961764Medicaid
G04928Medicare UPIN
TN3871717Medicare PIN
TN103I163616Medicare PIN