Provider Demographics
NPI:1730995226
Name:WHITE, DARNELL ANDRE
Entity type:Individual
Prefix:
First Name:DARNELL
Middle Name:ANDRE
Last Name:WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8409 DUNWOODY PL
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-3367
Mailing Address - Country:US
Mailing Address - Phone:177-069-6484
Mailing Address - Fax:
Practice Address - Street 1:7345 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4415
Practice Address - Country:US
Practice Address - Phone:017-706-9648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist