Individual
JASON LANTZ WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDMT
Contact information
Practice address
3280 MITCHELL BLVD, MOODY A F B, GA 31699-1500
(229) 257-2105
Mailing address
3807 ROBIN LN, VALDOSTA, GA 31605-5124
(229) 560-1598
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
02/01/2012
Last updated
02/01/2012
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