1174935787 NPI number — AICA ORTHOPEDICS, P.C.

Table of content: (NPI 1174935787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174935787 NPI number — AICA ORTHOPEDICS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AICA ORTHOPEDICS, P.C.
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:
AICA ORTHO SPINE PC
Provider Other Organization Name Type Code:
4
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:
1174935787
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 674508
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30006-0076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-701-2225
Provider Business Mailing Address Fax Number:
678-701-2226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1624 VIRGINIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLLEGE PARK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-781-2225
Provider Business Practice Location Address Fax Number:
404-781-2226
Provider Enumeration Date:
05/30/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ACQUAH
Authorized Official First Name:
FRANCIS
Authorized Official Middle Name:
K
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
770-968-5611

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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