Provider Demographics
NPI:1730181520
Name:WHITE, MICHAEL ALEX (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALEX
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7433
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-0002
Mailing Address - Country:US
Mailing Address - Phone:662-244-8393
Mailing Address - Fax:423-339-1448
Practice Address - Street 1:294 CHUBBY DR
Practice Address - Street 2:SUITE #2
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-1358
Practice Address - Country:US
Practice Address - Phone:662-244-8393
Practice Address - Fax:662-244-8392
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11125174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00116143Medicaid
MS050046302OtherMEDICARE RAILROAD
MS050000325Medicare ID - Type Unspecified
MS00116143Medicaid