Active NPI
Horace Roger White, M.D.
- Internal Medicine Physician
- Marietta, GA
National Provider Identifier
1215001144
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 16447
- Practice address
- 49 S Marietta Pkwy SW
#C
Marietta, GA 30064-3288 - Phone
- (770) 424-0647
- Fax
- (770) 590-5990
- NPI assigned
- Nov 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 16447 | GA | Primary |
Addresses
Primary practice location
49 S Marietta Pkwy SW
#C
Marietta, GA 30064-3288
Mailing address
1660 Cavan Dr SW
Marietta, GA 30064-2942
Phone (770) 424-1782
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 582142384 | Other | GA | TRICARE |
| 00193223F | Medicaid | GA | |
| 110092128 | Other | GA | RAIL ROAD MEDICARE |
| 1215001144 | Other | GA | BLUE CROSS BLUE SHIELD |
| 5986187 | Other | GA | CIGNA |
| 582142384 | Other | GA | MAIL HANDLERS |
| 124860510967 | Other | GA | HUMANA |
| 4231143 | Other | GA | AETNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16447 | GA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211155200000",
"number": "1215001144",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1660 CAVAN DR SW",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300642942",
"telephone_number": "770-424-1782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "49 S MARIETTA PKWY SW",
"address_2": "#C",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300643288",
"telephone_number": "770-424-0647",
"fax_number": "770-590-5990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITE",
"first_name": "HORACE",
"middle_name": "ROGER",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-20",
"last_updated": "2008-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "GA",
"license": "16447",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "582142384",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00193223F",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAIL ROAD MEDICARE",
"identifier": "110092128",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "1215001144",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "5986187",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAIL HANDLERS",
"identifier": "582142384",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA",
"identifier": "124860510967",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4231143",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.