1033276407 NPI number — PIEDMONT MEDICAL CARE CORPORATION

Table of content: (NPI 1033276407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033276407 NPI number — PIEDMONT MEDICAL CARE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIEDMONT MEDICAL CARE CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033276407
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 102321
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30368-2321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-367-7690
Provider Business Mailing Address Fax Number:
404-367-2584

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 HIGHWAY 34 E
Provider Second Line Business Practice Location Address:
BLDG 300
Provider Business Practice Location Address City Name:
NEWNAN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30265-1330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-304-0987
Provider Business Practice Location Address Fax Number:
770-304-0534
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AQUINO
Authorized Official First Name:
CHRISTY
Authorized Official Middle Name:
F
Authorized Official Title or Position:
DIRECTOR, PROVIDER ENROLLMENT
Authorized Official Telephone Number:
470-895-0214

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000340535G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com