1215251640 NPI number — SOMEONE CARES, INC. OF ATLANTA

Table of content: (NPI 1215251640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215251640 NPI number — SOMEONE CARES, INC. OF ATLANTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOMEONE CARES, INC. OF ATLANTA
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:
EARLY DETECTION INTERVENTION CLINIC
Provider Other Organization Name Type Code:
3
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:
1215251640
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1950 SPECTRUM CIR SE STE 200
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:
30067-8469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-921-2706
Provider Business Mailing Address Fax Number:
877-850-1971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1950 SPECTRUM CIR SE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30067-8469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-921-2706
Provider Business Practice Location Address Fax Number:
877-850-1971
Provider Enumeration Date:
03/14/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BASS
Authorized Official First Name:
RONNIE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
678-921-2706

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)

  • Identifier: 11D1094206 . This is a "CLIA CERTIFICATION" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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