Organization
BENNIE R WHITE JR MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENNIE RUSSELL WHITE JR. MD (PRESIDENT)
(770) 775-2341
Entity
Organization
Contact information
Practice address
794 MCDONOUGH RD, SUITE 105, JACKSON, GA 30233-1572
(770) 775-2341
(770) 775-3668
Mailing address
794 MCDONOUGH RD, SUITE 105, JACKSON, GA 30233-1572
(770) 775-2341
(770) 775-3668
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
56245
GA
Other
Enumeration date
04/12/2008
Last updated
04/12/2008
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