Bennie R White Jr MD Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

56245 Issued in GA

Legal business name

BENNIE R WHITE JR MD INC

Practice address

794 McDonough Rd
Suite 105
Jackson, GA 30233-1572

Phone

(770) 775-2341

Fax

(770) 775-3668

NPI assigned

Apr 12, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Bennie Russell White Jr., MDNPI 1376575225

Title

President

Phone

(770) 775-2341

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bennie R. White Jr., MD

  • Family Medicine Physician
  • Jackson, GA
  • NPI 1376575225

  GA

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1207958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207958400000",
    "number": "1306019104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "794 MCDONOUGH RD",
            "address_2": "SUITE 105",
            "city": "JACKSON",
            "state": "GA",
            "postal_code": "302331572",
            "telephone_number": "770-775-2341",
            "fax_number": "770-775-3668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "794 MCDONOUGH RD",
            "address_2": "SUITE 105",
            "city": "JACKSON",
            "state": "GA",
            "postal_code": "302331572",
            "telephone_number": "770-775-2341",
            "fax_number": "770-775-3668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENNIE R WHITE JR MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-12",
        "last_updated": "2008-04-12",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "BENNIE",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-775-2341",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "56245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Jackson, GA
• Primary Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.