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Individual

JONATHAN STEPHEN WHITE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
144 JACK FARRAR LN, TULLAHOMA, TN 37388-2398
(931) 455-0120
Mailing address
PO BOX 681789, FRANKLIN, TN 37068-1789
(931) 455-0120

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA713
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1516338
TN
01
P01328036
RAILROAD MEDICARE
TN
Enumeration date
12/13/2006
Last updated
08/13/2015
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