Provider Demographics
NPI:1053412486
Name:WHITE, DARIN MICHAEL (DPT, ECS)
Entity type:Individual
Prefix:DR
First Name:DARIN
Middle Name:MICHAEL
Last Name:WHITE
Suffix:
Gender:M
Credentials:DPT, ECS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-0370
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:706-494-3008
Practice Address - Street 1:6262 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-3540
Practice Address - Country:US
Practice Address - Phone:706-494-3193
Practice Address - Fax:706-494-3201
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT-26416, EN-432251E1300X
NCP77692251E1300X
ALPT79742251E1300X
GAPT0123702251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I657852Medicare PIN
GA202I657848Medicare PIN
CAPT0264160Medicaid