| Bennie R White Jr Md Inc | |
|
794 Mcdonough Rd Suite 105 Jackson GA 30233-1572 | |
| (770) 775-2341 | |
| (770) 775-3668 |
| Full Name | Bennie R White Jr Md Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 794 Mcdonough Rd, Jackson, Georgia |
| Authorized Official Name and Position | Bennie Russell White (PRESIDENT) |
| Authorized Official Contact | 7707752341 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bennie R White Jr Md Inc 794 Mcdonough Rd Suite 105 Jackson GA 30233-1572 Ph: (770) 775-2341 | Bennie R White Jr Md Inc 794 Mcdonough Rd Suite 105 Jackson GA 30233-1572 Ph: (770) 775-2341 |
| NPI Number | 1306019104 |
|---|---|
| Provider Enumeration Date | 04/12/2008 |
| Last Update Date | 04/12/2008 |
| Medicare PECOS PAC ID | 4587736145 |
|---|---|
| Medicare Enrollment ID | O20080626000614 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306019104 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 56245 (Georgia) | Primary |
| Provider Name | Bennie R White |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376575225 PECOS PAC ID: 3870592645 Enrollment ID: I20070326000211 |
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