Individual
BENNIE R. WHITE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
207Q00000X
Family Medicine Physician
Primary
056245
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
345029068A
—
GA
Enumeration date
07/07/2006
Last updated
12/18/2012
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