Organization
WHITE-WILSON ASSOCIATION, P.A.
Active
Organization
WHITE-WILSON ASSOCIATION, P.A.
Active
Other names
White-Wilson Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
ALAN L GIESEMAN (CEO)
(850) 863-8150
Entity
Organization
Contact information
Practice address
999 MAR WALT DR, FORT WALTON BEACH, FL 32547-6758
(850) 863-8150
(850) 863-4152
Mailing address
1005 MAR WALT DR, FORT WALTON BEACH, FL 32547-6707
(850) 863-8150
(850) 863-4152
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
059722800
—
FL
01
—
99017
FLORIDA BLUE
FL
Enumeration date
03/04/2022
Last updated
03/04/2022
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