1194812347 NPI number — ATLANTA INFECTIOUS DISEASE SPECIALISTS PC

Table of content: (NPI 1194812347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194812347 NPI number — ATLANTA INFECTIOUS DISEASE SPECIALISTS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTA INFECTIOUS DISEASE SPECIALISTS PC
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:
1194812347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
960 JOHNSON FERRY RD NE
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30342-1631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-851-0081
Provider Business Mailing Address Fax Number:
404-851-0077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
960 JOHNSON FERRY RD NE
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30342-1631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-851-0081
Provider Business Practice Location Address Fax Number:
404-851-0077
Provider Enumeration Date:
10/09/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MALONEY
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
404-851-0081

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  020679 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 022831 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 056179 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X , with the licence number: 020679 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X , with the licence number: 022831 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X , with the licence number: 056179 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00381169C / D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00381169C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 263262310A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00265746C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".