Organization
SPORTS MEDICINE AND REHABILITATIVE THERAPY
Active
Other names
SMART
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY WHITE MD (OWNER)
(912) 385-2333
Entity
Organization
Contact information
Practice address
182 SUNSET BLVD, JESUP, GA 31545-0401
(912) 385-2333
(912) 385-2350
Mailing address
PO BOX 5048, MACON, GA 31208-5048
(912) 385-2333
(912) 385-2350
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
26436
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DQ8290
RAILROAD MEDICARE
GA
Enumeration date
05/03/2010
Last updated
05/09/2011
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