Provider Demographics
NPI:1780966515
Name:WHITE, JEREMY JASON (DO/PHD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:JASON
Last Name:WHITE
Suffix:
Gender:M
Credentials:DO/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 BLUE LEAF DR
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-3887
Mailing Address - Country:US
Mailing Address - Phone:786-351-5729
Mailing Address - Fax:
Practice Address - Street 1:1514 VERNON RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4131
Practice Address - Country:US
Practice Address - Phone:770-874-6873
Practice Address - Fax:678-235-6758
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11193207P00000X
VA0102207033207P00000X
OKDO2305207P00000X
GA069461207P00000X
ALDO.1547207P00000X
NVDO2305207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine