Dolly Penn White, MD, MSCR is a medicare enrolled "Preventive Medicine - Public Health & General Preventive Medicine" physician in Canton, Georgia. Her current practice location is
111 Mountain Brook Dr Ste 100, Canton, Georgia. You can reach out to her office (for appointments etc.) via phone at
(678) 880-9654.
Dolly Penn White is licensed to practice in Georgia (license number 81812) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1669609442.
Physician's Profile
| Full Name | Dolly Penn White |
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| Gender | Female |
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| Speciality | Preventive Medicine - Public Health & General Preventive Medicine |
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| Location | 111 Mountain Brook Dr Ste 100, Canton, Georgia |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1669609442
- Provider Enumeration Date: 06/18/2009
- Last Update Date: 10/02/2023
Medicare PECOS Information:
- PECOS PAC ID: 8123243581
- Enrollment ID: I20210706002442
Medical Identifiers
Medical identifiers for Dolly Penn White such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1669609442 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 2083P0901X | Preventive Medicine - Public Health & General Preventive Medicine | D81335 (Maryland) | Secondary |
| 208D00000X | General Practice | 81812 (Georgia) | Secondary |
| 2083P0901X | Preventive Medicine - Public Health & General Preventive Medicine | 81812 (Georgia) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dolly Penn White allows following entities to bill medicare on her behalf.
| Entity Name | Good Samaritan Health Center Of Cobb |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1881923126
PECOS PAC ID: 7214970482
Enrollment ID: O20050608000595 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dolly Penn White is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Dolly Penn White, MD, MSCR
111 Mountain Brook Dr Ste 100,
Canton, GA 30115-9045
Ph: (678) 880-9654 | Dolly Penn White, MD, MSCR
111 Mountain Brook Dr Ste 100,
Canton, GA 30115-9045
Ph: (678) 880-9654 |
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