| Entity Name: | WHITE-WILSON ASSOCIATION, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 10 May 2007 (18 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 08 Apr 2016 (9 years ago) |
| Document Number: | P07000056377 |
| FEI/EIN Number | 26-0152605 |
| Address: | 1005 MAR-WALT DRIVE, FORT WALTON BEACH, FL, 32547, US |
| Mail Address: | 1005 MAR-WALT DRIVE, FORT WALTON BEACH, FL, 32547, US |
| ZIP code: | 32547 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1831846336 | 2022-03-04 | 2022-03-04 | 1005 MAR WALT DR, FORT WALTON BEACH, FL, 325476707, US | 999 MAR WALT DR, FORT WALTON BEACH, FL, 325476758, US | |||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||
| Phone | +1 850-863-8150 |
| Fax | 8508634152 |
Authorized person
| Name | ALAN L GIESEMAN |
| Role | CEO |
| Phone | 8508638150 |
Taxonomy
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | FLORIDA BLUE |
| Number | 99017 |
| State | FL |
| Issuer | MEDICAID |
| Number | 059722800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PERSAUD KENNETH MD | Agent | 1005 MAR-WALT DRIVE, FORT WALTON BEACH, FL, 32547 |
| Name | Role | Address |
|---|---|---|
| Dali John CMD | President | 1005 MAR-WALT DRIVE, FORT WALTON BEACH, FL, 32547 |
| Name | Role | Address |
|---|---|---|
| Hansen Christopher MMD | Vice President | 1005 MAR-WALT DRIVE, FORT WALTON BEACH, FL, 32547 |
| Name | Role | Address |
|---|---|---|
| Nagda Krishan MD | Chairman | 1005 MAR-WALT DRIVE, FORT WALTON BEACH, FL, 32547 |
| Name | Role | Address |
|---|---|---|
| Henry Aaron MD | Treasurer | 1005 MAR-WALT DRIVE, FORT WALTON BEACH, FL, 32547 |
| Name | Role | Address |
|---|---|---|
| Brown Vergil MD | Secretary | 1005 MAR-WALT DRIVE, FORT WALTON BEACH, FL, 32547 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-04-30 | PERSAUD, KENNETH, MD | No data |
| AMENDMENT | 2016-04-08 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2008-07-14 | 1005 MAR-WALT DRIVE, FORT WALTON BEACH, FL 32547 | No data |
| CHANGE OF MAILING ADDRESS | 2008-07-14 | 1005 MAR-WALT DRIVE, FORT WALTON BEACH, FL 32547 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2008-07-14 | 1005 MAR-WALT DRIVE, FORT WALTON BEACH, FL 32547 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-24 |
| ANNUAL REPORT | 2022-04-21 |
| ANNUAL REPORT | 2021-04-20 |
| ANNUAL REPORT | 2020-04-21 |
| ANNUAL REPORT | 2019-04-22 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-04-26 |
| ANNUAL REPORT | 2016-04-25 |
| Amendment | 2016-04-08 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
