Provider Demographics
NPI:1619798972
Name:WHITE, YAKEISSA SHONTA
Entity type:Individual
Prefix:
First Name:YAKEISSA
Middle Name:SHONTA
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 DAVIS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-3015
Mailing Address - Country:US
Mailing Address - Phone:404-808-5672
Mailing Address - Fax:
Practice Address - Street 1:747 DAVIS RD STE 200
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-3015
Practice Address - Country:US
Practice Address - Phone:404-808-5672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACO26618332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment