1184768384 NPI number — CEYLON M ROWLAND MD

Table of content: CEYLON M ROWLAND MD (NPI 1184768384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184768384 NPI number — CEYLON M ROWLAND MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROWLAND
Provider First Name:
CEYLON
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1184768384
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1000
Provider Second Line Business Mailing Address:
DEPT 978
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38148-0978
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-758-9900
Provider Business Mailing Address Fax Number:
901-752-2335

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1251 WESLEY DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38116-6442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-395-2630
Provider Business Practice Location Address Fax Number:
901-395-2631
Provider Enumeration Date:
02/19/2007

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: 207V00000X , with the licence number:  52202 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 36806 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 657786408 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".