Provider Demographics
NPI:1861795411
Name:WHITE, COLAY ANQUANETTE (OD)
Entity type:Individual
Prefix:DR
First Name:COLAY
Middle Name:ANQUANETTE
Last Name:WHITE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4002 NOBLE CREEK DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-5127
Mailing Address - Country:US
Mailing Address - Phone:404-704-4232
Mailing Address - Fax:
Practice Address - Street 1:2402 SOUTHLAKE MALL
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2334
Practice Address - Country:US
Practice Address - Phone:770-961-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-20
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist