BENNIE R WHITE JR MD INC (NPI# 1306019104) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306019104 |
| Entity Type | Organization |
| Organization Name | BENNIE R WHITE JR MD INC |
| Practice Address |
794 Mcdonough Rd Suite 105 Jackson GA 30233-1572 |
| Practice Telephone | 7707752341 |
| Practice Fax Number | 7707753668 |
| Mailing Telephone | 7707752341 |
| Mailing Fax Number | 7707753668 |
| Enumeration Date | 2008-04-12 |
| Last Update Date | 2008-04-12 |
| Authorized Official Name | DR. BENNIE RUSSELL WHITE JR. (PRESIDENT) |
| Authorized Official Telephone | 7707752341 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
56245 | GA | Ambulatory Health Care Facilities |
| Street Address |
794 MCDONOUGH RD SUITE 105 |
| City | JACKSON |
| State | GA |
| Zip Code | 30233-1572 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558330522 | Renal Treatment Centers Mid Atlantic Inc | Clinic/Center | 794 Mcdonough Rd, Jackson, GA 30233-1572 | 2006-03-14 |
| 1740755719 | Byron A Thompson | Counselor | 794 Mcdonough Rd, Jackson, GA 30233 | 2018-10-05 |
| 1750789947 | Select Interventional Pain, PC | Pain Medicine | 794 Mcdonough Rd, Suite 108, Jackson, GA 30233-1572 | 2014-12-20 |
| 1306126529 | Jaimi Marie Norrell | Nurse Practitioner | 794 Mcdonough Rd, 111, Jackson, GA 30233-1572 | 2011-08-18 |
| 1992943195 | Dana B Bass Burch | Physician Assistant | 794 Mcdonough Rd, Suite 111, Jackson, GA 30233-1572 | 2009-01-26 |
| 1093963944 | South Georgia Treatment, Inc | Clinic/Center | 794 Mcdonough Rd, Jackson, GA 30233-1572 | 2008-09-04 |
| 1306025630 | Derrell Levohn Leggett | Anesthesiology | 794 Mcdonough Rd, Suite 108, Jackson, GA 30233-1572 | 2007-11-02 |
| 1033329198 | Jackson Dialysis Center | Clinic/Center | 794 Mcdonough Rd, Suite 108, Jackson, GA 30233-1572 | 2007-05-23 |
| 1376575225 | Bennie R. White Jr. | Family Medicine | 794 Mcdonough Rd, Suite 105, Jackson, GA 30233-1572 | 2006-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366800914 | Georgia Ophthalmologists LLC | Durable Medical Equipment & Medical Supplies | 860 W 3rd St, Jackson, GA 30233 | 2016-02-10 |
| 1306225057 | Young Dreaden | Nurse Practitioner | 2978 Hwy 36w, Jackson, GA 30233 | 2015-05-28 |
| 1609255520 | Neta J Roby | Nurse Practitioner | Hwy 36, Georgia Diagnostic Classification Prison, Jackson, GA 30233 | 2015-05-26 |
| 1033546098 | Henrietta Lindsay | Social Worker | 463-b Ernest Biles Dr, Jackson, GA 30233 | 2013-10-04 |
| 1255776993 | Gareth Gene Walker | Technician | 514 Covinton Street, Jackson, GA 30233 | 2013-05-08 |
| 1730489592 | Mary L. Melton | Licensed Practical Nurse | 463 Ernest Biles Dr., Jackson, GA 30233 | 2010-10-27 |
| 1083864250 | Chastity Moore Brown | Dentist | 1520 Lucky Street, Griffin, GA 30233 | 2008-09-24 |
| 1568661320 | Joseph Fowlkes | Internal Medicine | 2978 Highway 36 W, Jackson, GA 30233 | 2007-07-12 |
| 1942386289 | Butts County Board of Commissioners | Ambulance | 154 Sylvan Drive, Jackson, GA 30233 | 2006-10-30 |
| 1841238300 | Jackson Pharmacy Services | Pharmacy | 22 Mulberry St., Jackson, GA 30233 | 2006-06-04 |
| Find all providers in zip 30233 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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|---|---|---|---|---|
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| 1366928087 | Primary Care - South Limited | Clinic/Center | 1385 South Highland Ave, Suite B-1, Jackson, TN 38301 | 2018-07-16 |
| 1114427507 | Advance Care, LLC | Clinic/Center | 14 Northtown Dr Ste 105, Jackson, MS 39211-3018 | 2018-02-13 |
| 1467841742 | Dc Medical Services Inc | Clinic/Center | 7 Stonebridge Blvd Ste C, Jackson, TN 38305-2049 | 2015-01-09 |
| 1558779728 | Rural Health Group, Inc. | Clinic/Center | 9742 Nc Highway 305, Jackson, NC 27845-9799 | 2014-07-31 |
| 1043573199 | Fondren Medical Clinic | Clinic/Center | 4436 N State St, Suite A-1, Jackson, MS 39206-5334 | 2012-06-22 |
| 1043503832 | Mid Jackson Family Health Clinic | Clinic/Center | 514c Woodrow Wilson Dr, Jackson, MS 39216 | 2011-05-26 |
| 1053646190 | More Convenient Care Center LLC | Clinic/Center | 4612 Medgar Evers Blvd, Suite 10, Jackson, MS 39213-5205 | 2009-10-07 |
| 1518121326 | University Nursing Associates Pllc | Clinic/Center | 136 W Ash St, Jackson, MS 39202-2217 | 2008-07-11 |
| 1114194347 | Community Action Committee of Pike County | Clinic/Center | 14590 St Rt 93, Family Health Center Jackson, Jackson, OH 45640 | 2008-05-16 |
| Find all providers in JACKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.