Individual
MR. ANTONIO WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1408 N HIGHLAND AVE STE 306, JACKSON, TN 38301-3450
(731) 736-1090
(731) 736-1760
Mailing address
1408 N HIGHLAND AVE STE 306, JACKSON, TN 38301-3450
(731) 736-1090
(731) 736-1760
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q018345
—
TN
Enumeration date
09/20/2017
Last updated
07/21/2022
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