1205011954 NPI number — DR. KRISTINE BORDEN WHIGHAM PSYD

Table of content: DR. KRISTINE BORDEN WHIGHAM PSYD (NPI 1205011954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205011954 NPI number — DR. KRISTINE BORDEN WHIGHAM PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHIGHAM
Provider First Name:
KRISTINE
Provider Middle Name:
BORDEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BORDEN
Provider Other First Name:
KRISTINE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSYD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205011954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 JOHNSON FERRY RD
Provider Second Line Business Mailing Address:
DEPARTMENT OF NEUROPSYCHOLOGY
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-785-2856
Provider Business Mailing Address Fax Number:
404-785-2851

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5455 MERIDIAN MARK RD
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-785-2856
Provider Business Practice Location Address Fax Number:
404-785-2851
Provider Enumeration Date:
12/31/2007

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: 103TC0700X , with the licence number:  PSY003130 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103G00000X , with the licence number: PSY003130 , registered in the state of GA ; 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