1285734848 NPI number — DR. AMBER BARTLETT ARAGON M.D.

Table of content: DR. AMBER BARTLETT ARAGON M.D. (NPI 1285734848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285734848 NPI number — DR. AMBER BARTLETT ARAGON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARAGON
Provider First Name:
AMBER
Provider Middle Name:
BARTLETT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PHILLIPS
Provider Other First Name:
AMBER
Provider Other Middle Name:
BARTLETT
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285734848
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1334
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JESUP
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31598-1334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-427-0800
Provider Business Mailing Address Fax Number:
912-427-6029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 PROFESSIONAL CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JESUP
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31545-0044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-427-0800
Provider Business Practice Location Address Fax Number:
912-427-6029
Provider Enumeration Date:
09/24/2006

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: 207X00000X , with the licence number:  0101239335 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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