Individual
DR. JEWEL JOHNNY WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
105 W STONE DR, STE 1F, KINGSPORT, TN 37660-3365
(423) 857-2793
(423) 578-8025
Mailing address
PO BOX 9, KINGSPORT, TN 37662
(423) 857-2793
(423) 578-8025
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD 16405
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3025660
—
TN
05
—
5850002
—
VA
Enumeration date
06/01/2005
Last updated
05/20/2014
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