Individual
MR. BYRON KEITH WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
607 PINNIX RD, BURLINGTON, NC 27217-8555
(336) 227-1289
Mailing address
PO BOX 3334, BURLINGTON, NC 27215-0334
(336) 227-1289
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-001-107
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7804722
—
NC
Enumeration date
01/11/2007
Last updated
07/08/2007
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