# WHITE-WILSON MEDICAL CENTER, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WHITE-WILSON MEDICAL CENTER, P.A.
- **Other names:** White-Wilson Medical Center DFK
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1063267128
- **Legal business name:** WHITE-WILSON MEDICAL CENTER, P.A.
- **Authorized official:** KENNETH PERSAUD (CEO)
- **Authorized official phone:** (850) 863-8150

## Contact information

- **Practice address:** 1045 US HIGHWAY 331 S, DEFUNIAK SPRINGS, FL 32435-3379
- **Practice address phone:** (850) 892-3366
- **Practice address fax:** (833) 451-2226
- **Mailing address:** 1005 MAR WALT DR, FORT WALTON BEACH, FL 32547-6707
- **Mailing address phone:** (850) 863-8299
- **Mailing address fax:** (850) 863-4152

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/22/2024
- **Last updated:** 08/01/2024