White, Deidra

White, Deidra is an individual health care provider with primary practice located at 699 Church St Ne Suite 340, Marietta GA 30060-1110. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. White, Deidra can be contacted via phone (678) 355-1620.

Contact Information

Primary practice address
699 Church St Ne Suite 340 Marietta GA 30060-1110
Phone: (678) 355-1620
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 117058 Georgia
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X RN 117058 NP Georgia

Profile Details

NPI number 1568595775
LBN Legal business name White, Deidra
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 14th, 2007
Last updated Sep 11th, 2018 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568595775 NPPES
Georgia MEDICAID 00810917B

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