1275839797 NPI number — DR. NICE PSYCHIATRY LLC

Table of content: (NPI 1275839797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275839797 NPI number — DR. NICE PSYCHIATRY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. NICE PSYCHIATRY LLC
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:
1275839797
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 71819
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWNAN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30271-1819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-253-6001
Provider Business Mailing Address Fax Number:
770-253-6402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1933 HIGHWAY 34 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWNAN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30265-1327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-253-6001
Provider Business Practice Location Address Fax Number:
770-253-6402
Provider Enumeration Date:
01/31/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JONES-NICE
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER / RENDERING PROVIDER
Authorized Official Telephone Number:
770-253-6001

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  052124 , 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)