Individual
GREGORY WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
920 CLAIRMONT AVE, DECATUR, GA 30030-1201
(404) 377-6111
Mailing address
97 DAHLGREN ST SE, ATLANTA, GA 30317-1649
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA000628
GA
Other
Enumeration date
11/29/2012
Last updated
11/29/2012
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