Basic Information
| Provider Information | |||||||||
| NPI: | 1891975454 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | PHERMELA | ||||||||
| MiddleName: | SUMMERS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 MOUNTAIN MEADOW LN | ||||||||
| Address2: | |||||||||
| City: | ROCK SPRING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307392651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042814641 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6098 DEBRA RD STE 5200 | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238936500 | ||||||||
| FaxNumber: | 4238923785 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2007 | ||||||||
| LastUpdateDate: | 07/09/2019 | ||||||||
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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 | 122300000X | DS0000008647 | TN | N | Dental Providers | Dentist | 1223G0001X | DS0000008647 | TN | Y | Dental Providers | Dentist | General Practice |
No ID Information.