1275855504 NPI number — LINDSEY L WITT WHNP

Table of content: LINDSEY L WITT WHNP (NPI 1275855504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275855504 NPI number — LINDSEY L WITT WHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WITT
Provider First Name:
LINDSEY
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
WHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WATRUD
Provider Other First Name:
LINDSEY
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275855504
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2959 SHARPSBURG MCCULLUM RD
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:
30265-2297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-683-8346
Provider Business Mailing Address Fax Number:
770-916-7642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2959 SHARPSBURG MCCOLLUM RD
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:
30265-2297
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-683-8346
Provider Business Practice Location Address Fax Number:
770-916-7642
Provider Enumeration Date:
03/01/2010

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: 363LW0102X , with the licence number:  RN180347 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: RN180347 , 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)

  • Identifier: RN180347 . This is a "GEORGIA LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".