Basic Information
| Provider Information | |||||||||
| NPI: | 1609246826 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | RONNIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 E WATTS ST | ||||||||
| Address2: | |||||||||
| City: | ENTERPRISE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 363302511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343936688 | ||||||||
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| Practice Location | |||||||||
| Address1: | 107 E WATTS ST | ||||||||
| Address2: | |||||||||
| City: | ENTERPRISE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 363302511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343936688 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2015 | ||||||||
| LastUpdateDate: | 09/30/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 2244 | AL | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.