Individual
JOHN MAXWELL WHITE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 MEDICAL PARK BLVD, BRISTOL, TN 37620-7430
(423) 844-1121
Mailing address
1021 W OAKLAND AVE STE 310, JOHNSON CITY, TN 37604-2192
(423) 302-6565
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
028233
GA
208800000X
Urology Physician
35C.001118
OH
208800000X
Urology Physician
Primary
69973
TN
208800000X
Urology Physician
EMC0005417
MI
208800000X
Urology Physician
MD61499859
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000328237E
—
GA
01
—
208282
BLUE CROSS BLUE SHIELD
GA
01
—
P00019582
RAILROAD MEDICARE
—
Enumeration date
06/27/2006
Last updated
12/31/2024
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