1295723005 NPI number — JAMES MILTON POINDEXTER JR. MD, FACS

Table of content: JAMES MILTON POINDEXTER JR. MD, FACS (NPI 1295723005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295723005 NPI number — JAMES MILTON POINDEXTER JR. MD, FACS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POINDEXTER
Provider First Name:
JAMES
Provider Middle Name:
MILTON
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD, FACS
Provider Gender Code:
M

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:
1295723005
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 54888
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30308-0888
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-350-9505
Provider Business Mailing Address Fax Number:
404-350-1611

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1718 PEACHTREE ST NW
Provider Second Line Business Practice Location Address:
SUITE 360
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30309-2452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-350-9505
Provider Business Practice Location Address Fax Number:
404-350-1611
Provider Enumeration Date:
10/06/2005

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: 2086S0129X , with the licence number:  029071 , 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: 00338379C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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