1144525684 NPI number — GEORGE WALLACE CULPEPPER NRP, CCEMT-P, FP-C

Table of content: GEORGE WALLACE CULPEPPER NRP, CCEMT-P, FP-C (NPI 1144525684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144525684 NPI number — GEORGE WALLACE CULPEPPER NRP, CCEMT-P, FP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CULPEPPER
Provider First Name:
GEORGE
Provider Middle Name:
WALLACE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NRP, CCEMT-P, FP-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CULPEPPER
Provider Other First Name:
G.
Provider Other Middle Name:
WALLACE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NRP, CCEMT-P, FP-C
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1144525684
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1546 FITZPATRICK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WETUMPKA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36092-3729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6600 VAN AALST BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT BENNING
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31905-2102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
762-408-2140
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 146L00000X , with the licence number:  9700560 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com