Basic Information
| Provider Information | |||||||||
| NPI: | 1861795411 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | COLAY | ||||||||
| MiddleName: | ANQUANETTE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4002 NOBLE CREEK DR NW | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303275127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047044232 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2402 SOUTHLAKE MALL | ||||||||
| Address2: | |||||||||
| City: | MORROW | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302602334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709611001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2010 | ||||||||
| LastUpdateDate: | 12/21/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 002600 | GA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.