Provider Demographics
NPI:1447508643
Name:DR. VICTORIA WARNER-WHITE
Entity type:Organization
Organization Name:DR. VICTORIA WARNER-WHITE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAYALTOR
Authorized Official - Middle Name:E
Authorized Official - Last Name:FULTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-576-6464
Mailing Address - Street 1:2040 DAN PROCTOR DR STE 230
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-3801
Mailing Address - Country:US
Mailing Address - Phone:912-576-6464
Mailing Address - Fax:
Practice Address - Street 1:2040 DAN PROCTOR DR STE 230
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3801
Practice Address - Country:US
Practice Address - Phone:912-576-6464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039504208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty